Director, Prior Authorization
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.
- 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
Years of Experience:
Skills & Abilities: