Supervisor Utilization Management Review

Amerihealth Caritas•Newark, DE

4d•Remote

About The Position

The Utilization Management Review Supervisor manages a remote team of up to 15 Utilization Management Reviewers who process prior authorization requests and concurrent reviews for Medicaid members in the Delaware market. The supervisor provides clinical, technical, and operational guidance to staff, oversees workflow and inventory, and helps the team meet operational goals through performance monitoring, auditing, coaching, and training. This is a remote role with a Monday-through-Friday schedule from 8:00 a.m. to 5:00 p.m. EST. The supervisor must also be able to work weekends and evenings based on business needs, and 4 to 5 recognized company holidays, including Thanksgiving and Christmas, on a rotating basis. A reliable high-speed internet connection is required for remote work, with minimum bandwidth of 50 Mbps download and 5 Mbps upload.

Requirements

Associate Degree in Nursing.
At least 5 years of diverse independent clinical practice experience in an acute care setting.
At least 3 years of experience performing prior authorization and concurrent reviews for a managed care organization.
Experience leading a team of remote Utilization Management Reviewers.
Current and unencumbered Registered Nurse licensure in Delaware or Nursing Licensure Compact (NLC).
Strong analytical and problem-solving skills to review cases and identify trends.
High level of attention to detail to ensure accuracy in reviews.
Excellent communication skills for interacting with staff, healthcare providers, and potentially members.
Proficiency with Microsoft Office applications, including Outlook, Word, Excel, Teams, and PowerPoint.
Familiarity with Electronic Medical Record (EMR) and healthcare documentation software.
Proficiency with InterQual and a proven track record of applying the criteria to complex Medicaid cases.
Ability to work weekends and evenings based on business needs, and 4 to 5 recognized company holidays, including Thanksgiving and Christmas, on a rotating basis.
For remote work, access to reliable high-speed internet with minimum bandwidth of 50 Mbps download and 5 Mbps upload.

Nice To Haves

Bachelor Degree in Nursing.

Responsibilities

Provide daily oversight, support, and direction to a remote team of Utilization Management Reviewers.
Offer guidance on clinical and technical aspects of the review process.
Manage daily operations, monitor work assignments, and adjust assignments based on staffing and request volume.
Ensure the team meets operational goals through auditing, coaching, and training.
Oversee prior authorization request inventory and manage workflow to ensure timely processing.
Monitor team productivity and other performance indicators to help the team achieve operational goals.