Supervisor Behavioral Health Utilization Management ...

Role OverviewThe Supervisor Behavioral Health Utilization Management Review manages a remote team of 10 Behavioral Health Utilization Management Reviewers who process prior authorization requests and concurrent reviews across multiple markets to include LA, NH, OH, NC, and DC. In this role, you will provide clinical, technical, and operational guidance to staff, oversee workflow and inventory, and ensure the team meets its goals through performance monitoring, auditing, coaching, and training.Work Arrangement Remote role. Must be able to work during standard business hours during Central Standard Time. Hours can be worked in either 8 hour or 10 hour shifts Must be able to work Saturdays as part of the work schedule Must be able to work 2 recognized company holidays per year Responsibilities Team supervision: Provide daily oversight, support, and direction to a remote team of Utilization Management Reviewers Clinical and technical support: Offer guidance on clinical and technical aspects of the review process Operational oversight: Manage daily operations, including monitoring work assignments and adjusting based on staffing and request volume Performance management: Ensure the team meets operational goals through auditing, coaching, and training Inventory and workflow management: Oversee the inventory of prior authorization requests and manage workflow to ensure timely processing Goal achievement: Monitor team productivity and other performance indicators to help the team achieve its operational goals Education and Experience Registered Nurse candidates: Associate Degree in Nursing (required) or Bachelor Degree in Nursing (preferred) Licensed Social Work candidates: Master Degree in Social Work required Minimum of 2 years of independent clinical practice experience assessing and treating individuals with behavioral health and substance use disorders in a clinical setting Experience using evidence based clinical criterion to process prior authorization requests and concurrent reviews for behavioral health and substance use disorder cases Minimum of 1 year of experience leading a remote behavioral health utilization management team in a managed care organization Experience managing productivity and reports, coaching and educating staff, and identifying areas of opportunity within SOPs and workflows to improve productivity Licensure LMSW candidates must have active and unencumbered professional licensure in Louisiana: LPC, LMSW, LCSW, LISW RN candidates must have active and unencumbered Louisiana license and/or Nursing License Compact (NLC) Ability to obtain additional licensure in OH, NC, DC, and NH within 12 months of employment Skills and Abilities Proficiency applying InterQual and American Society of Addiction Medicine (ASAM) criterion to complex behavioral health Medicaid cases Proficiency in Microsoft Office to include Teams, Word, Excel and Outlook is required. Ability to type with speed and accuracy Strong analytical and problem-solving skills to review cases and identify trends A high level of attention to detail to ensure accuracy in reviews Excellent communication is required for interacting with staff, healthcare providers, and potentially members Familiarity with Electronic Medical Record (EMR) and healthcare documentation software Your career starts now. We are looking for the next generation of healthcare leaders.At AmeriHealth Caritas, 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 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. We want to connect with you if you want to make a difference. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with over 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 Our Comprehensive Benefits PackageFlexible 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.As a company, we support internal diversity through:Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.

Created: 2026-03-10