BusinessOperations - Authorization Specialist II - J00904

For Iowa Plan Only: A bachelor s degree with 30 semester hours or equivalent quarter hours in a human services field (including, but not limited to, psychology, social work, mental health counseling, marriage and family therapy, nursing, education, occupational therapy, and recreational therapy) and at least one year of experience in the delivery of services to the population groups that the person is hired as a case manager or case management supervisor to serve; or An Iowa license to practice as a registered nurse and at least three years of experience in the delivery of services to the population group the person is hired as a case manager or case management supervisor to serve. Bachelor s degree in Human Services related field defined as: Child, Family and Community Services, Early Child Development, Guidance and Counseling, Home Economics- Child and Family Services, Human Development Counseling, Human Service Administration, Human Services, Master of Divinity, Pastoral Care, Pastoral Counseling, Psychiatric Nursing, Psychiatry, Psychology, Public Administration, Rehabilitation Counseling, Social Science, Social Services/Social Work or Sociology.

Position Purpose:
Acts as a resource and supports the prior authorization request process to ensure that all authorization requests are addressed properly in the contractual timeline. Supports utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access.

Education/Experience:
Requires a High School diploma or GED
Requires 1 2 years of related experience
Knowledge of medical terminology and insurance preferred.


Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines

Supports the authorization review process by researching and documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination

Verifies member insurance coverage and/or service/benefit eligibility via system tools and aligns authorization with the guidelines to ensure a timely adjudication for payment

Performs data entry to maintain and update various authorization requests into utilization management system

Supports and processes authorization requests for services in accordance with the insurance prior authorization list and routes to the appropriate clinical reviewer

Remains up-to-date on healthcare, authorization processes, policies and procedures
Performs other duties as assigned

Complies with all policies and standards

EEO:

Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.

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Education/Experience: Requires a Bachelor's degree and 1 year of related experience. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. For Iowa Plan Only: A bachelor s degree with 30 semester hours or equivalent quarter hours in a human services field (including, but not limited to, psychology, social work, mental health counseling, marriage and family therapy, nursing, education, occupational therapy, and recreational therapy) and at least one year of experience in the delivery of services to the population groups that the person is hired as a case manager or case management supervisor to serve; or An Iowa license to practice as a registered nurse and at least three years of experience in the delivery of services to the population group the person is hired as a case manager or case management supervisor to serve . For Illinois Plan Only: In addition to the requirements above the employee working on Physically Disabled/Elderly Candidate must meet one of the 3 following criteria: 1. RN licensed in Illinois. 2. Bachelor or Master s Degree prepared in human services related field. Bachelor s degree in Human Services related field defined as: Child, Family and Community Services, Early Child Development, Guidance and Counseling, Home Economics- Child and Family Services, Human Development Counseling, Human Service Administration, Human Services, Master of Divinity, Pastoral Care, Pastoral Counseling, Psychiatric Nursing, Psychiatry, Psychology, Public Administration, Rehabilitation Counseling, Social Science, Social Services/Social Work or Sociology. 3. LPN with one (1) year experience in conducting comprehensive assessments and provision of formal service for the elderly Brain Injury/HIV/AIDS Candidate must meet one of the 3 following criteria: 1. A Registered Nurse (RN) licensed in Illinois and a bachelor s degree in nursing, social work, social sciences or counseling or four (4) years of case management experience 2. Certified or Licensed social worker with Bachelor s degree in either social work, social sciences or counseling or a Masters of social work 3. Unlicensed social worker: minimum of bachelor s degree in social work, social sciences, or counseling In addition to meeting one of the above criteria, must have experience working with: " Addictive and dysfunctional family systems " Racial and ethnic minorities " Homosexuals and bisexuals " Persons with AIDS, and " Substance abusers . For Superior Health Plan Only: Direct experience working with individuals who have disabilities and/or with vulnerable populations who have chronic or complex conditions, including children and young adults within three of the last five years. Other state specific requirements may apply. required. Responsibilities Evaluates the needs of the member, the resources available, and recommends and/or facilitates the plan for the best outcome Assists with developing ongoing long-term care plans/service plans and works to identify providers, specialist, and/or community resources needed for long-term care Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified services are accessible to members Provides resource support to members and their families/caregivers for various needs (e.g. employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans Monitors care plans/service plans, member status and outcomes, as appropriate, and provides recommendations to care plan/service plan based on identified member needs Interacts with long-term care healthcare providers and partners as appropriate to ensure member needs are met Collects, documents, and maintains long-term care member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators May perform on-site visits to assess member's needs and collaborates with providers or resources, as appropriate Provides and/or facilitates education to long-term care members and their families/caregivers on procedures, healthcare provider instructions, service options, referrals, and healthcare benefits Provides feedback to leadership on opportunities to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner Performs other duties as assigned Complies with all policies and standards
Story Behind the Need
What is the purpose of this team? What is driving this need? (ex. Backfill for FTE or CW, new project, business growth) Describe the surrounding team (team culture, work environment, etc.) & key projects. Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?	The Authorization Intake team is responsible for receiving, reviewing, and creating prior authorization requests for multiple Texas Medicaid lines of business, including STAR, STAR+, CHIP, STAR Kids, and STAR Health. The team ensures requests are accurately entered, routed appropriately, and processed within regulatory turnaround time requirements to support timely member access to care. This request is driven by increased business volume and operational demands following the July 1, 2026 platform and vendor transition. Intake is experiencing sustained high authorization inventory, increased provider outreach, additional Transition of Care (TOC) and Evolent-related workload, and ongoing training requirements for newer staff members. Contingent workers are needed to provide additional capacity, maintain turnaround time compliance, reduce dependency on overtime, and support growing authorization volumes while permanent staffing needs are evaluated. Recent volume reporting reflects significant increases in authorization inventory, Evolent transition work, provider inquiries, and productivity impacts associated with new hire training and system changes. The Intake team operates in a fast-paced, highly collaborative environment focused on quality, compliance, and customer service. Team members work closely with clinical review, determinations, correspondence, provider relations, and leadership teams to ensure timely processing of authorization requests. The culture emphasizes teamwork, cross-training, continuous learning, and adaptability in response to evolving business needs. At this time, the request is focused on obtaining contingent support to address immediate operational needs and volume demands. Leadership will continue to monitor inventory trends, productivity metrics, business growth, and workload associated with ongoing transition activities to determine whether additional staffing requests are warranted in the future. The contingent workforce will provide flexibility to manage fluctuating volumes while maintaining service levels and regulatory compliance.
Typical Day in the Role
Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD). What are performance expectations/metrics? What makes this role unique?		Authorization Specialist II team members are responsible for receiving, reviewing, validating, and creating prior authorization requests for multiple Medicaid products. Daily responsibilities include researching member and provider information, ensuring requests contain required documentation, building authorizations, conducting provider outreach for missing information, routing requests appropriately, documenting actions, and managing worklist inventory to meet turnaround time requirements. The team also supports transition-of-care activities, provider education, and special initiatives related to authorization processing. Success in the role is measured through productivity, quality, and turnaround time compliance. Specialists are expected to maintain daily production goals, accurately build authorizations, follow regulatory and business requirements, minimize processing errors, and manage inventory to prevent overdue requests. Team members are also expected to contribute to department goals related to volume management, quality audits, and service excellence. This role serves as the front end of the utilization management process and has a direct impact on timely member access to care. Specialists work with a wide variety of authorization types, provider groups, and Medicaid programs while collaborating closely with clinical reviewers, provider relations, and operations leadership. The position offers continuous learning opportunities through evolving healthcare regulations, system enhancements, workflow improvements, and cross-functional partnerships.