AmeriHealth Caritas · 9 hours ago
Manager Utilization Management Administration Operations & Correspondence
United States
Full-time
Remote
Mid, Senior Level
3+ years expAmeriHealth Caritas is a mission-driven organization focused on providing comprehensive healthcare solutions. The role is responsible for overseeing the Utilization Management Correspondence team, ensuring compliance with regulatory requirements and managing daily operations to support efficient healthcare delivery.
Health CareInformation Technology
Responsibilities
Manages and maintains all regulatory requirements for all members and provider notifications and works in collaboration with other leadership in different lines of business to maintain contractual compliance with notifications
Provides oversight of the daily operations of licensed professionals on the Utilization Admin Ops and Correspondence team. Oversees and manages staff responsible for all letter-elated tasks and requirements, including
New/Updating template implementation process
Maintaining/overseeing the approved templates for new business when there is not a mandated letter template from the state or other accrediting body
Maintaining/overseeing the approved templates and ensuring updates are made timely if change is received from a state or accrediting body
Oversee the management of the delegate letter process: creation, review, approval, configuration and testing process
Oversee/escalate any delegate letter issues of noncompliance expeditiously
Provides oversight to the dedicated team trained in correspondence/communication requirements for all denials and any additional informational letters that need issued in accordance with state/plan or accrediting body requirements
Assesses candidates and ensures that optimal qualifications are met as a member of the department’s interview team
Plans, develops and supports or conducts orientations, training programs and creates educational material for staff members to improve skills, aid in professional growth and development and to ensure staff’s expertise
Reviews quality audits and shares audit results in a timely manner with associates, providing necessary education and counseling to improve performance
Works collaboratively with the Director and other identified leadership to develop and implement performance measures, and monitors associates placed on performance improvement plans
Responsible for writing and finalizing annual reviews for direct reports with Director input
Participates in process reviews and the development of new and/or revised work processes, policies and procedures relating to Utilization Review Correspondence process
Acts as a liaison with outsides entities, including, but not limited to, delegated vendors, and regulatory agencies
Creates and supports an environment that fosters teamwork, cooperation, respect, and diversity
Establishes and maintains positive communication and professional demeanor with internal and external customers, providers and members at all times
Stays current with ACFC policies and procedures and Medicaid, Medicare and Marketplace requirements
Qualification
Required
Bachelor of Science in Nursing (BSN)
Minimum of 3 years of progressive experience in an acute care setting
Minimum 3 years utilization management review in a managed care organization
Experience managing a remote team of utilization management reviewers
Experience operationalizing individual state contract requirements, translating complex legal contract language into day-to-day operational workflows
Experience managing and maintaining NCQA standards and CMS guidelines as it relates to work processes, policies and procedures for approval and denial correspondence to both members and providers
Current and unencumbered Nurse Licensure Compact (NLC)
Proficiency with Microsoft Office Suite
Ability to type with speed and accuracy
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