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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 Newtown Square, 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 LTSS Manager/Director for Utilization Management, this position is responsible for providing daily oversight of LTSS Review Home Modification Team and staff members within the LTSS Review Utilization Management Department. Responsibilities include providing technical and operational support and direction, including organization and monitoring of all LTSS services.; Responsible for direct supervisory oversight of professional and front line staff receiving requests for authorizations from Service Coordinators which encompasses participants.

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+ Assists in the day-to-day operations of the LTSS Review Home Modification and LTSS UM Department, including authorization and approval of services, appeals and the coordination of benefits for all LTSS Participants.

+ Assists staff in handling satisfaction issues related to Home Modifications and responds to legal, regulatory affairs and OLTL inquiries.

+ Prepare reports and conduct analysis of operations / services as required by departmental, corporate, regulatory, and State requirements.;

+ Work collaboratively with Information Services Department on identifying required data for reporting.

+ Assists with daily operations of professionals in the LTSS UM Review Department.

+ Monitors staff work assignments and makes appropriate adjustments based on staffing levels, staff experience, and number/request types of authorizations/appeals received.

+ Provides coaching and counseling to improve productivity of staff members within the LTSS Review UM Department.

+ Works collaboratively across various teams including HADME and Service Coordination department of LTSS.

+ Assesses candidates and ensures that optimal qualifications are met as a member of the department’s interview team.

+ Plans, develops and supports or conducts orientations, training programs and creates educational material for staff members to improve skills, aid in professional growth and development and to ensure staff’s expertise.

+ Reviews quality audits and shares audit results in a timely manner with associates, providing necessary education and counseling to improve performance.

+ Responsible for writing and finalizing annual reviews for direct reports with Manager input.

+ Participates in process reviews and the development of new and/or revised work processes, policies and procedures relating to LTSS Utilization Review.

+ Accurately answers questions regarding CHC benefits for members and providers.

+ Creates and supports an environment that fosters teamwork, cooperation, respect, and diversity.

+ Establishes and maintains positive communication and professional demeanor with internal and external customers, providers and participants at all times.

+ Maintains operational processes, policies, procedures and reports to support LTSS care delivery.

+ Stays current with;ACFC policies and procedures, Medicaid, CHC requirements, Building Codes, ADA and UFAS Standards

+ Knowledge of and commitment to the Independent Living Philosophy

+ Assist with oversight of; Home Modification process and projects as well as coordinates with Home Modification Providers and Project Managers as needed to ensure open communication, progress and completion of approved Home Modifications.

+ Perform modification assessments of participants homes as needed.

+ Travel as determined by manager and/or director to meet the needs of the business in Pennsylvania.

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Education/ Experience:;

+ Bachelor’s degree or equivalent relevant experience

+ Unrestricted Registered Nurse (RN) or Physical Therapist (PT)

+ Valid Driver’s license in the state of residency

+ Local travel required

+ 3 years of experience in Managed Care Utilization Review

+ Minimum of 1-3 years of Director Supervisory experience

+ Ability to research and become proficient with ADA accessible design implementation.

+ Ability to research existing ordinances and codes related to design, construction and occupancy.

+ Strong communication and organizational skills required.

+ Ability to manage/oversee multiple projects simultaneously.

+ Proficiency with Microsoft Office Suite (Word, Excel, Power Point).

+ Experience in Home Health, and/or Home and Community Based Services is preferred.

+ Knowledgeable in basic data analytics as related to aggregating, distinguishing, and displaying data for reporting purposes.

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Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including 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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As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.