Job Description

Location: Health Choice Management Co.
Posted Date: 7/16/2020

Position Purpose:

The Director of Prior Authorization oversees the non-clinical day-to-day operations of the Prior Authorization Department. Responsibilities include proactive planning, organization and oversight of operations ensuring the highest quality of care and serves are provider in the most efficient manner. The Director focuses on achieving outcomes, meeting and/or exceeding regulatory standards as it relates to prior authorization.

Responsibilities:

  • Monitor and maintain reporting of prior authorization operations and processes, monitor and report department compliance standards to Medical Management and Health Plan Leadership
  • Implement and develop utilization reports and collaborate with Medical Management to identify trends, develop and implement innovative action plans to improve quality, accuracy and efficiency
  • Lead and provide oversight for all health plan audits, monitor all department reporting to ensure data is accurate, develop and implement department work plans, collaborate with Medical Management on strategic planning and initiatives, collaborate with Health Plan Leadership and Department Heads
  • develop, implement and maintain department policies and procedures, communicate job expectations to staff, oversight of employee evaluations and personnel actions, lead the department in positive communication and team building
  • Leads the charge in focus and implementation of the organization's culture and strategic plan in a way that aligns to the mission, vision and values of the organization.

Education / Experience / Other Requirements

Education:

  • Master’s Degree in Healthcare or related field

Years of Experience:

  • At least 5 years customer service experience and/or health care related field
  • At least 5 years Managerial experience
  • Previous experience working with Medicare and Medicaid Health Plans preferred

Specialized Knowledge:

  • Requires excellent writing skills.
  • Requires demonstrated competence in project management with strong conceptual, communications, design and organizational skills.
  • Complete tasks with little supervision
  • Ability to lead others
  • Ability to think analytically and make independent decisions
  • Ability to manage multiple projects and prioritize work tasks to adhere to deadlines and identified time frames

Skills & Abilities:

  • Must be able to effectively communicate with internal and external customers via telephone and email.
  • Able to accurately receive information through oral communication.
  • Able to accurately review data and figures both in hard copy and electronic formats.
  • Utilize a computer (including but not limited to a mouse and keyboard) and telephone intermittently throughout entire shift, for periods of up to four (4) hours at a time.
  • Able to accurately sort through data and think through issues in a timepressured environment.
  • Able to focus on a specific event or activity for up to four (4) hours at a time without interruption.
  • Able to maintain a calm and collected presence while addressing the concerns from an internal and external customer
  • Able to accurately learn and retain new information, knowledge and skills.
  • Able to efficiently manage multiple tasks, with varying degrees of priority, at the same time.

Application Instructions

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