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AmeriHealth Caritas · 1 month ago

Supervisor Utilization Management Review

United States

Full-time

Remote

Senior Level

5+ years exp

AmeriHealth Caritas is a mission-driven organization dedicated to providing comprehensive healthcare solutions. The Utilization Management Review Supervisor oversees a remote team of clinical reviewers managing prior authorization requests, ensuring operational goals are met through performance monitoring and guidance.

Health CareInformation Technology

H1B Sponsor Likely

Responsibilities

Team supervision: Provide daily oversight, support, and direction to a remote team of Utilization Management Reviewers

Clinical and technical support: Offer guidance on clinical and technical aspects of the review process

Operational oversight: Manage daily operations, including monitoring work assignments and adjusting based on staffing and request volume

Performance management: Ensure the team meets operational goals through auditing, coaching, and training

Inventory and workflow management: Oversee the inventory of prior authorization requests and manage workflow to ensure timely processing

Goal achievement: Monitor team productivity and other performance indicators to help the team achieve its operational goals

Qualification

Clinical practice experiencePrior authorization reviewsNurse Licensure CompactMicrosoft Office proficiencyInterQual proficiencyAnalytical skillsEMR familiarityAttention to detailCommunication skills

Required

Associate's Degree in Nursing

Minimum of 5 years of clinical practice experience in an acute care setting

Minimum of 3 years of experience performing prior authorization reviews and/or concurrent reviews in a managed care environment

Experience leading a remote Utilization Management team in a health plan

Current and unencumbered Nurse Licensure Compact (NLC)

Ability to obtain RN in District of Columbia within 6 months from date of hire

Strong analytical and problem-solving skills to review cases and identify trends

A high level of attention to detail to ensure accuracy in reviews

Excellent communication is required for interacting with staff, healthcare providers, and potentially members

Demonstrated proficiency in Microsoft Office applications to include Outlook, Word, Excel, Teams, PowerPoint

Familiarity with Electronic Medical Record (EMR) and healthcare documentation software

Proficiency with InterQual and proven track record of applying the criteria to complex Medicaid cases

Preferred

Bachelor's Degree in Nursing

Benefits

Flexible work solutions including remote options

Hybrid work schedules

Competitive pay

Paid time off including holidays and volunteer events

Health insurance coverage for you and your dependents on Day 1

401(k)

Tuition reimbursement

Company

AmeriHealth Caritas

Glassdoor3.4

AmeriHealth Caritas is the health care solutions provider for those in most need and the chronically ill.

Founded in 1982

Philadelphia, Pennsylvania, USA

10001+ employees

http://www.amerihealthcaritas.com

H1B Sponsorship

AmeriHealth Caritas has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (18)

2024 (17)

2023 (12)

2022 (14)

2021 (4)

2020 (11)