AmeriHealth Caritas ยท 20 hours ago
Supervisor Behavioral Health Utilization Management Review
United States
Full-time
Remote
Mid, Senior Level
3+ years expAmeriHealth Caritas is a mission-driven organization with over 30 years of experience in healthcare solutions, seeking a Supervisor for Behavioral Health Utilization Management Review. This role involves managing a remote team of reviewers, providing clinical and operational guidance, and ensuring the team meets its performance goals through effective oversight and support.
Health CareInformation Technology
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
Required
Associate Degree in Nursing (required) or Bachelor Degree in Nursing (preferred) for Registered Nurse candidates
Master Degree in Social Work required for Licensed Social Work candidates
Minimum of 2 years of independent clinical practice experience assessing and treating individuals with behavioral health and substance use disorders in a clinical setting
Experience using evidence based clinical criterion to process prior authorization requests and concurrent reviews for behavioral health and substance use disorder cases
Minimum of 1 year of experience leading a remote behavioral health utilization management team in a managed care organization
Experience managing productivity and reports, coaching and educating staff, and identifying areas of opportunity within SOPs and workflows to improve productivity
LMSW candidates must have active and unencumbered professional licensure in Louisiana: LPC, LMSW, LCSW, LISW
RN candidates must have active and unencumbered Louisiana license and/or Nursing License Compact (NLC)
Ability to obtain additional licensure in OH, NC, DC, and NH within 12 months of employment
Proficiency applying InterQual and American Society of Addiction Medicine (ASAM) criterion to complex behavioral health Medicaid cases
Proficiency in Microsoft Office to include Teams, Word, Excel and Outlook is required. Ability to type with speed and accuracy
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
Familiarity with Electronic Medical Record (EMR) and healthcare documentation software
Preferred
Bachelor Degree in Nursing for Registered Nurse candidates
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
AmeriHealth Caritas is the health care solutions provider for those in most need and the chronically ill.
10001+ employees
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)
Funding
Current Stage
Late StageLeadership Team
Kathleen Giblin
SVP Clinical Operations
Ash Hanson
Executive Vice President & Chief Human Resources Officer
Recent News
2025-11-06
The Philadelphia Inquirer
2025-10-02
2025-10-01
Company data provided by crunchbase