We're one of the largest healthcare companies in the area and growing! Our organization is currently seeking a Prior Authorizations, Supervisor. . We offer full benefits, PTO, great schedules and growth!
If you're interested, please apply today! We start onsite interviews over the next 5-10 business days!
· Supervise the Utilization Review team to include selection, training and development, coaching, counseling and performance management.
· Manage weekly/monthly production and quality reports to identify trends and manage UR staff recommending actions for process and procedure improvements to increase production, quality and compliance within the Utilization Management (UM) and UR department.
· Oversee day-to-day operations of utilization review activities to include assessing and providing training, but not limited to Clerical Intake, UR functions to include RAI process, Clerical Back-end verifications, turn-around time (TAT) requirements, audit readiness, and account exceptions.
· Key liaison for department associate’s education related to UM function.
· Assist in establishing UM goals, performance and quality measures, and report key performance indicators (KPI’s).
· Assess volume of utilization review requests and assign appropriately.
· Guide and oversee maintenance and improvement of utilization review files – paper and electronic on company system.
· Assure proper procedure and processes are in place for proper auditing and reporting of accuracy and compliance of the work that is completed by utilization management staff.
· Establish and maintain the utilization management/review procedural manual and keeping it current.
· Serve as a liaison for client specific inquires related to utilization review functions.
· Track trends and updates in the utilization management/review compliance arena.
· Compile and report utilization management/review metrics for specific client reports and provide UM procedures for client UM audit tools.
Required Skills for Prior Authorizations, Supervisor
· Preferred bachelor's degree or equivalent combination or experience and education.
· Licensed Practical Nurse or Registered Nurse Preferred.
· Three (3) plus years of related experience in managing in a quality and production environment preferably in the healthcare field.
· Minimum of 1 year experience in a health plan Prior Authorization role.
· Ability to understand optical Rx and medical technology preferred
If this sounds like something you would be a good fit for, please apply today! We start onsite interviews over the next 7-10 business days!