Supervisor Utilization Management Review

Amerihealth Caritas Health Plan Washington , DC 20319

Posted 3 months ago


Job Summary:

Under the supervision of the Senior Manager and Manager of Utilization Management, the Supervisor, is responsible to provide workflow and clinical direction, organization, and monitoring of all Utilization Management services. Responsible for direct supervisory oversight of the Utilization Management Service Unit staffs, who are performing concurrent review, discharge planning, case management and other supportive functions.

Job Related Qualifications/Knowledge/Skills/Abilities:

  • Required Registered Nurse graduated from an accredited Diploma, Associate's Degree or Bachelor's Degree program required.

  • Required Current and active RN licensure in the District of Columbia in good standing.

  • Required minimum 3-5 years progressively responsible experience in a clinical environment

  • Required 1-2 years utilization management/case management.

  • Required solid PC skills required (Word, Excel and PowerPoint); ability to analyze and interpret data.

  • Required 3 years of current and progressive supervisory level experiences to include team leader or charge nurse.

  • Required valid driver's license required (and reliable transportation for requested offsite work related activities.

  • Highly Preferred knowledge of discharge planning, outpaient clinical reviews transition care.

  • Preferred Managed care or Commercial Insurance.


  • Excellent organizational, time management and leadership skills.

  • Excellent verbal, written and interpersonal communication skills.

  • Proven ability to work effectively as a member and leader of a multi-disciplinary team. Ability to lead or influence others positively to achieve desired work results and ability to work effectively with others to achieve desired goals.

  • Analytical skills to evaluate problems and develop alternative solutions.

  • Participates in staff education and development programming.


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Supervisor Utilization Management Review

Amerihealth Caritas Health Plan