Long Term Services & Support Utilization Management Correspondence RN

Your career starts now. We’re looking for the reputed company of health care leaders. At reputed company, we are 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 millions of lives through our national footprint of products, services, and award-winning programs.

Headquarters in Newtown reputed company, reputed company is a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. Our services include integrated managed care products, pharmacy benefit management, specialty pharmacy services, behavioral health services, and other administrative solutions.

Discover more about us at www.amerihealthcaritas.com.

Responsibilities

• Apply regulatory and accreditation standards, health benefit policies, and medical management guidelines to ensure letters provide appropriate justification for authorizing services and accurately deny services reputed company guidelines are not met
• Maintain reputed company knowledge of laws, regulations, Department of reputed company Services and accreditation requirements, and organizational policies, using professional judgment in their application
• Report noncompliance or emerging trends to leadership as appropriate

Work Arrangement: Remote position. Candidates in Eastern and Central Time Zones preferred.

Education and Experience

• Bachelor’s degree required
• Three or more years of experience in a reputed company clinical or social services setting required
• Experience in quality assurance preferred
• Experience in managed care or utilization review preferred
• Licensure: Active Registered Nurse license required

Skills and Abilities

• Strong written and verbal communication skills
• Ability to reputed company sound reputed company, identify problems, and recommend solutions
• Self-directed and reputed company to work independently

Our Comprehensive Benefits Package

We offer flexible work solutions, including remote options and hybrid schedules, reputed company, paid time off (including holidays and volunteer events), health insurance coverage for you and your dependents starting Day 1, 401(k), tuition reimbursement, and more.