Utilization Management Plan Oversight Manager

10 hours ago


Dublin, Ohio, United States AmeriHealth Administrators Full time
Job Title: Utilization Management Plan Oversight Manager

We are seeking a highly skilled Utilization Management Plan Oversight Manager to join our team at AmeriHealth Caritas. As a key member of our healthcare leadership team, you will be responsible for overseeing the development and implementation of utilization management plans that ensure high-quality, cost-effective care for our members.

Key Responsibilities:
  • Develop and implement utilization management plans that align with regulatory requirements and company policies.
  • Collaborate with cross-functional teams to ensure seamless integration of utilization management processes.
  • Monitor and analyze data to identify trends and areas for improvement in utilization management.
  • Develop and implement process improvements to optimize utilization management outcomes.
  • Ensure compliance with regulatory requirements and company policies.
Requirements:
  • Bachelor's degree in a related field.
  • Current and unrestricted RN license in Ohio.
  • 3 years of utilization/case management experience in a relevant scope.
  • 3 years of relevant clinical practice experience.
  • Demonstrated ability to assess departmental work quality and develop/implement process improvements.
  • Experience managing multiple processes and influencing change.
  • Demonstrated competency in use of healthcare data.
What We Offer:
  • Competitive salary and benefits package.
  • Opportunities for professional growth and development.
  • Collaborative and dynamic work environment.
  • Recognition and rewards for outstanding performance.
About Us:

AmeriHealth Caritas is a mission-driven organization dedicated to improving the health and well-being of our members. We offer a comprehensive benefits package, flexible work arrangements, and a commitment to diversity, equity, and inclusion. If you are a motivated and results-driven professional looking for a challenging and rewarding opportunity, we encourage you to apply.



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