AmeriHealth Caritas

Long Term Services & Support Utilization Management Correspondence RN

Posted on

June 18, 2025

Job Type

Full-Time

Role Type

Utilization Review

License

RN

State License

Pennsylvania

Apply to This Job

Help & Resources

Company Description

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. We'd like to hear from you if you want to make a difference. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with over 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 Description

Requirements

Education/ Experience: Bachelor’s Degree required. Registered Nurse required. 3 or more years’ experience in a related clinical or social services setting required. Quality or QA experience preferred Managed care or utilization review experience preferred. Other Skills: Strong written and verbal communication skills Decision-making skills with the ability to identify problems and recommend solutions Self-directed, able to work independently.

Need help crafting an effective cover letter and resume for this role?

Get access to our expert resources: our proven framework offers successful strategies, helps you find the best-fit positions, craft standout cover letters, optimize your resume, and much more.

Get Started

Responsibilities

Under the direction of the Long-Term Services and Supports (LTSS) Supervisor, the LTSS UM Correspondence RN is responsible for creating, writing, editing, and completing all LTSS UM Review adverse decision notices within required timeframes. The LTSS UM QA Letter Analyst will use regulatory and accreditation departmental standards and apply medical health benefit policy and medical management guidelines to ensure letters provide the appropriate justification for authorizing services and appropriately deny services when guidelines are unmet. The QA Analyst will maintain current knowledge and understanding of the laws, regulations, DHS/NCQA requirements, and policies that pertain to the organizational unit’s business and use professional judgment in their application. ; This position will report noncompliance or other trends to leadership as appropriate.

Apply to This Job

Help & Resources

Our Resources Designed for Success

Nurses who follow our proven framework increase their chances of landing a remote telehealth role by 5x!

Telehealth

Starter Pack

Telehealth

Pro Toolkit

Telehealth

Mastery Suite

Price

$34 $79 $149

Resume Template Package

Checkmark Checkmark Checkmark
Matching Cover Letter Checkmark Checkmark Checkmark
Matching Reference Page Checkmark Checkmark Checkmark
Resume Tips and Tricks Checkmark Checkmark Checkmark
Resume Optimization Guide Checkmark Checkmark
7 Nurse Resume Examples Checkmark Checkmark
20+ Professional Summary Examples Checkmark Checkmark
How to Structure Unique Career Experiences Checkmark Checkmark

āœ…Career Accelerator Success Guide

Checkmark
šŸ”“Lifetime Premium Job Board Access

Checkmark
šŸ“ˆJob Application Tracker

Checkmark
⭐1:1 Expert Support & Mentorship

Checkmark

Basic

Telehealth

Starter Pack

$34

  • Checkmark

    Resume Template Package

    ATS optimized design for nurses

  • Checkmark

    Matching Cover Letter

  • Checkmark

    Matching Reference Page

  • Checkmark

    Resume Tips and Tricks

ADVANCED

Telehealth

Pro Toolkit

$79

  • Checkmark

    Everything from Starter Pack

  • Checkmark

    Resume Optimization Guide

  • Checkmark

    7 Nurse Resume Examples

  • Checkmark

    20+ Professional Summary Examples

  • Checkmark

    How to Structure Unique Career Experiences

BEST VALUE

Telehealth

Mastery Suite

$149

  • Checkmark

    Everything from Starter Pack

  • Checkmark

    Everything from Pro Toolkit

  • Checkmark

    Career Accelerator Success Guide

    Proven method for landing your dream role

  • Checkmark

    Lifetime Premium Job Board Access

  • Checkmark

    Application Tracker

  • Checkmark

    1:1 Expert Support