What are the responsibilities and job description for the Clinical Care Reviewer Utilization Management - RN required position at AmeriHealth Caritas?
Responsibilities
The Clinical Care Reviewer will be scheduled to CORE or FLEX hours to provide access to medical necessity determinations for urgent and contractually required coverage requests on a 24 / 7, 365 basis.
This description provides a general overview of the position, recognizing that day to day duties of each individual in the position may vary based on personal experience, skills, supervision, cases and other factors.
This is a great opportunity to work in a cohesive and team driven environment!
Education / Experience :
- Must have Registered Nurse or compact state licensure.
- Associate's Degree required. Bachelor's Degree of Nursing preferred.
- Registered Nurse graduated from an accredited program
- 3 years of clinical practice experience as a RN in ED, ICU, Med-Surg, or post acute care (SNF / rehab / LTAC) experience required.
- 1 years of Utilization Management experience desired, preferably in a Managed Care Organization.
- Demonstrated proficiency utilizing InterQual criterion preferred.
- Must be proficient working utilizing MS Office (Word, Excel, Teams, Outlook) within a Windows 11 environment, internet applications, and electronic medical record and documentation programs.
- Demonstrated ability to work independently within a remote environment.
- Able to meet scheduling requirement to work 4 out of 10 company recognized calendar holidays.
- Able to work occasional overtime and weekends based on business needs.
Diversity, Equity, and Inclusion
At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
We keep our associates happy so they can focus on keeping our members healthy.
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.
Generous paid time off and paid volunteer time off.
Employer-matched 401(k) and additional non-elective contributions, starting on day one.
Medical, dental, and vision plans — with coverage starting on day one.
Employee assistance programs, fitness reimbursements, nutrition counseling, and more.
Employer-paid life insurance, with opportunities to purchase additional coverage.
Employer-paid short-term disability coverage and long-term disability coverage.
Tuition assistance, including reduced tuition at certain schools.
Financial assistance with adoption, including paid time off.
Flexible spending and health savings accounts to pay for qualified expenses.
Discount programs on entertainment, travel, and more.
