Utilization Care Manager Jobs in Reston, VA (NOW HIRING)

Work Arrangement:

• Monday through Friday from 9:30 AM EST to 5:00 PM EST; 4 days must be worked in our DC office located at 1201 Maine Ave SW and 1 day can be worked remotely.
• This is a hybrid position. Associates are responsible for commuter cost however, company has a commuter benefit program.
• Must reside in the DC metro area. Office is in close proximity to two metro stations.

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Your career starts now. We are looking for the next generation of health care leaders.

At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations 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 would like to hear you.

Headquartered in Newtown Square, Pennsylvania, 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.

Responsibilities:

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.

Education/ Experience:

• High School/GED required.
• Associate's Degree or equivalent education & experience preferred
• Minimum of 1 year general office and/or customer service experience required
• Work experience in healthcare setting required
• Knowledge of medical terminology required
• Minimum of 1 year experience in Managed Care, Insurance, or Call Center experience required
• Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint) required.
• Consistent word processing speed and accuracy of 50 or more words per minute required

The targeted hiring range for this role is expected to be between $27.02 and $36.78 per hour.The range displayed in this job posting reflects the minimum and maximum for new hire salaries for the position in the D.C. office. Within the range, individual pay is determined by additional factors, including, without limitation, job-related skills, experience, and relevant education, certifications, or training. AmeriHealth Caritas associates are eligible to participate in our annual incentive program and will also receive our benefits package, consisting of medical, vision, dental, live insurance, disability insurance, 401(k), paid time off and more.

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.