Long Term Services & Support Utilization Management Technician

About the position

The Long Term Services & Support Utilization Management Technician position at AmeriHealth Caritas is a vital role that supports the organization's mission to provide comprehensive, outcomes-driven care to individuals in need. This remote position is designed for individuals who are passionate about healthcare and want to make a significant impact in the lives of others. The technician will work under the direction of the Long Term Services and Supports (LTSS) Supervisor, playing a crucial role in coordinating and managing various aspects of utilization management. In this role, the technician will be responsible for generating and tracking both incoming and outgoing correspondence, faxes, and authorizations related to prospective, concurrent, and post-service review functions. This includes interacting with providers and LTSS UM staff to facilitate the receipt of necessary information and records for prompt review and response. The technician will also provide verbal notifications to participants to maintain compliance under the CHC Final Agreement, ensuring that all processes are followed accurately and timely. Data entry is a significant part of this role, as the technician will be responsible for entering authorizations to ensure they are provided in a timely and accurate manner. Additionally, maintaining operational reports and working with providers to correct any authorization to claim issues will be essential tasks. The technician must remain knowledgeable about all workflow and timeliness requirements for all areas in Utilization Management, ensuring that the organization meets its operational goals and compliance standards.

Responsibilities
• Coordinate, generate and track both incoming and outgoing correspondence, faxes and authorizations related to prospective, concurrent and post service review functions.
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• Interact with providers and LTSS UM staff to facilitate receipt of information and/or records for prompt review and response.
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• Provide verbal notification to participants to maintain UM compliance under the CHC Final Agreement.
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• Perform data entry of authorizations to ensure authorizations are provided timely and accurately.
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• Maintain operational reports through data entry.
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• Work with Providers to correct authorization to claim issues.
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• Remain knowledgeable in all workflow and timeliness requirements for all areas in Utilization Management.

Requirements
• High School diploma or GED required.
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• Minimum 1 year general office and/or customer service experience required.
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• Work experience in a healthcare setting required.
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• Knowledge of medical terminology required.
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• 1 to 3 years of general office or customer service experience.

Nice-to-haves
• Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint); Access is a plus.
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• Consistent word processing speed and accuracy of 50 or more words per minute.

Benefits
• Flexible work solutions including remote options and hybrid work schedules.
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• Competitive pay.
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• Paid time off including holidays and volunteer events.
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• Health insurance coverage for you and your dependents on Day 1.
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• 401(k) plan.
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• Tuition reimbursement.

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