Offer summary

Qualifications:

High school diploma or equivalent required., Experience in healthcare or utilization management preferred., Strong analytical and problem-solving skills are essential., Proficiency in Microsoft Office Suite and healthcare software is a plus..

Key responsibilities:

Review and process utilization management requests from healthcare providers.

Ensure compliance with policies and regulations during the review process.

Communicate with healthcare providers to clarify information and resolve issues.

Maintain accurate records and documentation of all utilization management activities.

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 impact the lives of millions of people through our national footprint of products, services, and award-winning programs. Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 35 years of experience delivering 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 support services. In the process, we are dedicated to helping find solutions to end poverty so the American Dream is in reach for all.

Required profile