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! 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. Role Overview Under the direction of the Utilization Management Operations Administrative Supervisor, the Utilization Management (UM) Correspondence Registered Nurse (RN) is responsible for creation, writing, editing and completion of all utilization management review adverse decision notices and any additional informational letters in accordance with the appropriate state/plan requirements, within required timeframes. The UM Correspondence RN has oversight of behavioral and physical health approval and denial letters for Medicaid, Medicare, and the Exchange. In this role, you will use regulatory, accreditation, and departmental standards and apply medical health benefit policy and medical management guidelines to ensure letters provide the appropriate justification in authorizing services and appropriately deny services when guidelines are not met. The UM Correspondence RN will maintain current knowledge and understanding of the laws, regulations, DHS/NCQA requirements and policies that pertain to the organizational unit’s business and uses professional judgment in their application. This position will report noncompliance or other trends to leadership as appropriate. Work Arrangement • Remote role. • Monday through Friday from 8:00a EST to 5:00p EST. • Availability to work rotating weekends based on business needs is required. • Must work 4 out of 10 holidays to include Thanksgiving and Christmas (rotating).
AmeriHealth Caritas is a managed care organization that delivers integrated healthcare products and services including managed care, pharmaceutical benefit management, specialty pharmacy, behavioral health, and administrative services. They hire nurses for remote roles including Long Term Services and Supports reviewers who evaluate care and service requests, and Case Management supervisors who oversee case management units, provide clinical direction, and supervise staff conducting care coordination and screening activities.
