Remote Utilization Management Clinical Operations Liaison

RPMGlobal; Northern (KY); Hybrid; USD 60,000 - 90,000; Full time

Benefits offered by this job

Remote options

Hybrid work schedules

Competitive pay

Paid time off including holidays

Health insurance on Day 1

401(k)

Tuition reimbursement

Job summary

AmeriHealth Caritas is seeking a UM Clinical Administrative Operations Liaison to coordinate and monitor utilization management programs, supporting performance improvement and QA activities. The role interacts with policy updates, reporting, and accreditation preparation to ensure regulatory compliance.

The ideal candidate holds a Bachelor’s degree with at least 3 years in clinical quality improvement and utilization management, and demonstrates strong analytical, organizational, and

Qualifications

• Bachelor's degree preferred with clinical or service quality improvement experience.
• Minimum 3 years in clinical or service quality improvement.
• Minimum 3 years in Utilization Management Review Process.

Responsibilities

• Support annual UM work plan and program descriptions with leadership.
• Request and validate reports; escalate issues impacting goals.
• Identify errors/risks in audit files and communicate them to UM leadership.
• Review accreditation standards; update documents and training materials.
• Develop and maintain UM policies and procedures; collaborate across functions.
• Assist with contract changes; support training for UM teams.

Skills

Organizational skills

Analytical skills

Interpersonal skills

Written communication

Verbal communication

PC skills

Contract reading

Education

Bachelor's Degree

Job description

AmeriHealth Caritas is seeking a UM Clinical Administrative Operations Liaison to coordinate and monitor utilization management programs, supporting performance improvement and QA activities. The role interacts with policy updates, reporting, and accreditation preparation to ensure regulatory compliance.

The ideal candidate holds a Bachelor’s degree with at least 3 years in clinical quality improvement and utilization management, and demonstrates strong analytical, organizational, and