Manager Long Term Services & Support Utilization Management Review Non-Clinical

EST and CST applicants are preferred.

Your career starts now. We’re looking for the next generation of healthcare 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 healthcare 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.

Responsibilities:

The Manager LTSS UM Review Non-Clinical manages all elements of the Community HealthChoices Long Term Services and Supports (LTSS) Review Utilization Management Authorization program, including, but not limited to, LTSS Case Advisors, Appeals Liaison, LTSS Non-Clinical Supervisors, and LTSS UM Technicians. This includes functions related to authorization management, escalations, and other non-clinical programs. This position will collaborate with the Director of LTSS Clinical Services to create the department's operation and strategic plans.

This position will work closely with Information Solutions to provide technical oversight of projects related to authorizations and the utilization of automated programs. This includes monitoring and overseeing authorization reports and dashboards to ensure regulatory compliance with the CHC Agreement. It also includes implementing projects and process efficiencies to improve processes and reports to manage the team.

• Direct activities of the LTSS non-clinical associates. Oversee staff performance in terms of timely work and productivity.
• Will work closely with Supervisors to monitor QA reviews for associates.
• Ensure effective daily operations of the UM Technician and LTSS Case Advisor teams utilizing all applicable statutory provisions, contracts, agreements, and established policies and administrative procedures.;
• Maintain optimal staffing patterns based on contractual obligations and current LTSS non-clinical team budget. Comply with all policies and procedures for personnel requisitions, interviews, and employment. Maintain accurate position control and organizational charts of assigned departments.
• Prepare reports and conduct analyses of operations/services as required by departmental, corporate, regulatory, and State requirements. Collaborate with the Information Services Department to identify data needed for reporting.
• Works with the Information Services Department to develop reporting and dashboards for LTSS UM Authorizations.;
• Establish performance and productivity requirements and communicate expectations to the management team. Collaborate with Supervisors to identify individual and/or group deficiencies in scheduled Performance Reviews. Establish an action plan for assessing and resolving identified issues.
• Identifies systemic performance gaps and develops curriculum to address areas of concern.
• Comply with Corporate, Federal, and State confidentiality standards to protect members' identifiable health information appropriately.
• Works with the Director of LTSS Clinical Services to create the department's operational and strategic plans.
• Creates and supports an environment that fosters teamwork, cooperation, respect, and diversity.

Education/ Experience:;

• Bachelor’s Degree required.
• Registered Nurse required.
• One to three years of Utilization Management experience in relevant scope preferred; one year required.;
• One to three years of management experience required.;
• Experience with Home and Community Based Services preferred.;
• Demonstrated ability to assess the department’s work quality and develop/implement process improvements to achieve compliance with contractual and oversight.
• Demonstrated competency in the use of healthcare data;
• Excellent analytical and problem-solving skills
• Strong computer skills. ;Proficiency and speed working in all Microsoft Office Suite applications
• Experience working with the aged, blind, and/or disabled population is strongly desired.
• Understanding of and expertise in quality improvement and medical informatics.

Diversity, Equity, and Inclusion

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We implement these principles daily by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k) tuition reimbursement, and more.

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