AmeriHealth Caritas Utilization Management Technician in Philadelphia, Pennsylvania

Utilization Management Technician

Location: Philadelphia, PA

Telecommuter?: No

ID**: 16272

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 Philadelphia, 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 .

Responsibilities:

Under the general supervision of the Supervisor, Utilization Management, this position receives calls, faxes and portal submissions from providers regarding authorization requests and process inquiries for plan members.

Interacts with facilities, vendors, providers, and other staff to facilitate receipt of information, and /or records for prompt review and response. Screens information received from providers for needed information for authorization requests

  • Acts as a resource to staff for questions related to the prior authorization process.

  • Works with member service representatives who handle overflow calls.

  • Identifies and reports member and provider educational opportunities to the Supervisor.

  • Accurately answers questions regarding Utilization Management requirements for members and providers.

  • Supports Utilization Management nurses by generating and assigning cases for review.

  • Performs other duties as assigned.

Education/Experience:

  • High School diploma or GED equivalent.

  • Experience as a Medical Assistant or in another position with comparable responsibilities.

  • Experience handling multiple call lines and triaging calls.

  • Experience dealing with medical professionals and patients preferred.

  • Minimum of two years of experience dealing with the public.

  • Managed care experience preferred.

  • Medical terminology, ICD, CPT and coding experience preferred.

  • Availability for in-service training.

EOE Minorities/Females/Protected Veterans/Disabled