AmeriHealth Caritas Utilization Management Technician, Prior Authorization in Philadelphia, Pennsylvania

Utilization Management Technician, Prior Authorization


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. 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 supervision of the Supervisor for Utilization Management Review Non-Clinical, this position is responsible for providing select program interventions according to established health management program guidelines and the member population. The Care Connector functions with direction from the Supervisor/Manager Interacts with members, providers and internal staff to implement departmental interventions, document activities, assist providers in the authorization process and refer risk appropriate members to professional staff according to protocols.

  • Supports the daily operations of UM through interaction with staff, facilities, vendors and providers.
  • Maintains a current knowledge base of UM processes and timelines.
  • Using good listening skills, conducts outreach calls, collecting data according to script, tools, and protocols meeting both productivity and performance expectations as identified by unit supervisor/or designee. Conducts all calls in a courteous and customer service friendly manner. Refers as appropriate when indicated by workflow.
  • Creates, updates maintains and/or closes authorizations or tasks for services as assigned within process guidelines. Routes case to appropriate associates based on established guidelines.
  • Processes all incoming and outgoing correspondence/faxes in accordance with required standards and within respective timeliness guidelines. Refers to the appropriate clinical team members for review as defined by workflow.
  • Performs in a call center environment appropriately processing or triaging calls from members and providers.
  • Clerical responsibilities such as processing urgent scanning, mailing requests and document retrieval.
  • Demonstrates a professional and courteous manner when communicating with others with the ability to clearly and accurately state the agreed upon resolution.
  • Adhere to company Policies and Procedures, process standards, Standard Operating Procedures and maintains current knowledge of member benefits, rights and responsibilities.
  • Performs other related duties and projects as assigned within the assigned timeframes.
  • Adheres to company policies and procedures.

Education/Experience:

  • High School Diploma or equivalent required.
  • Strongly prefer medical assistant, home health aide, nursing assistant, or other similar health care para-professional training or certification; basic computer skills including MS Office (Word, Excel, and Outlook) and Internet applications.
  • Demonstrated ability to write and understand basic medical terminology.
  • 2+years of member service or customer service telephone experience within a managed care organization.