Long Term Services & Support Utilization Management Technician

Socket.dev; United States; On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

Remote options

Hybrid work schedules

Paid time off including holidays and—

Job summary

AmeriHealth Caritas in the United States seeks a LTSS UM Tech to support utilization management functions, coordinating authorizations and communications with providers.

Under the LTSS Supervisor, you will enter data, track correspondence, notify participants by phone, and help maintain timely reviews. A healthcare background and strong MS Office skills are preferred.

This role offers flexible work solutions including remote or hybrid schedules with competitive pay and benefits.

Qualifications

• High School/GED required.
• Minimum 1 year general office or customer service experience.
• Healthcare setting experience preferred.
• Knowledge of medical terminology beneficial.

Responsibilities

• Coordinate and track correspondence, faxes, and authorizations for UM reviews.
• Interact with providers and LTSS UM staff to obtain necessary records.
• Provide telephonic verbal notifications to participants to maintain UM compliance.
• Perform data entry of authorizations and maintain operational reports.
• Work with providers to correct authorization to claim issues.
• Maintain knowledge of workflow and timeliness requirements across UM areas.

Skills

MS Office

Data entry

Phone communication

Education

High School Diploma or GED

Job description

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

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

At AmeriHealth Caritas, we’re 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’d like to hear from 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.

Job Summary

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, service coordinators, and LTSS UM staff to facilitate receipt of information, and/or records for prompt review and response.

• Provides Telephonic 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.

• High School Diploma or GED required.

• Minimum 1 year general office and/or customer service experience required.

• Work experience in healthcare setting required.

• Knowledge of medical terminology required.
• 1 or 3 years General Office or Customer Service experience.

Other Skills

• Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint, Teams, One Note). Advanced Excel skills is a plus. Consistent word processing speed and accuracy of 50 or more words per minute. Proficiency with telephonic communications and speaking with Participants. Proficient working on computer all day with electronic records.

Our Comprehensive Benefits Package

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.