Role Overview

The Utilization Management (UM) Technician plays a crucial role by supporting the efficient and appropriate use of medical resources. They work under the direction of a supervisor and are responsible for a variety of tasks related to coordinating, tracking, and processing requests and authorizations for healthcare services.

Work Arrangement

• Remote: Central and Eastern time zones preferred

   

Responsibilities

Under the direction of the Long Term Services and Supports (LTSS) Supervisor, the LTSS UM Tech will:

• Coordinate, generate and track both incoming and outgoing correspondence, faxes and authorizations related to prospective, concurrent and post service review functions
• Interacts with providers and LTSS UM staff to facilitate receipt of information, and /or records for prompt review and response 
• Provides verbal notification to participants to maintain UM compliance under the CHC Final Agreement
• Performs data entry of authorizations to ensure authorizations are provided timely and accurately
• Performs data entry and maintains operational reports
• Works with Providers to correct authorization to claim issues
• Performs and remains knowledgeable in all workflow and timeliness requirements for all areas in Utilization Management
   

Education/ Experience:

• High School/GED
• Work experience in healthcare setting required
• Knowledge of medical terminology required
• 1 to 3 years General Office or  Customer Service Experience required
   

Skills & Abilities

• Proficiency with Microsoft Office Suite (Word, Excel, Power Point).  Access is a plus.  Consistent word processing speed and accuracy of 50 or more words per minute.
   

Our Comprehensive Benefits Package

Your career starts now. We are looking for the next generation of health care leaders.

At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to connect with you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

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 and more.