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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.
The Utilization Management Technician functions under the direction of the Supervisor to coordinate, generate and track both incoming and outgoing correspondence, faxes and authorizations related to prospective, concurrent and post service review functions. Interacts with facilities, vendors, providers, and other staff to facilitate receipt of information, and /or records for prompt review and response. Compensation plans for physicians, licensed nurse reviewers, staff, and consultants who conduct medical management do not contain incentives, directly or indirectly, that encourage barriers to care and service in making determinations.
- Supports the daily operations of Utilization Management team through interaction with staff, facilities, vendors and providers.
- Maintains a current knowledge base of Utilization Management processes and timelines.
- Uses 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 AmeriHealth 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, document retrieval, and projects as assigned.
- Demonstrates a professional and courteous manner when communicating with others with the ability to clearly and accurately state the agreed upon resolution.
- Adhere to AmeriHealth Policies and Procedures, process standards, and Standard Operating Procedures
- Performs other related duties and projects as assigned within the assigned timeframes.
- Adheres to AmeriHealth policies and procedures.
- Complies with AmeriHealth and HIPAA confidentiality standards to protect the confidentiality of member information
- High School Diploma or GED required.
- Minimum of 1 year of member service or customer service telephone experience in a call center environment desired.
- Working knowledge of medical terminology.
- Demonstrated ability to work within a fast paced environment and meet turnaround times for deliverables.
- Experience working in a productivity and metric based work environment.
- Experience initiating or processing requests for prior authorization, DME, and/or concurrent review.
- Demonstrated ability to utilize existing resources and engage critical thinking skills to seek out resolutions to problems.
- Demonstrated proficiency utilizing MS Office and Internet applications in a Windows based environment. Familiarity with electronic medical record and documentation programs.