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Prior Authorization Technician Supervisor

Expired Job

Iasis Healthcare Phoenix , AZ 85002

Posted 3 months ago

The Prior Authorization (PA) Supervisor coordinates and sees through the activities of the PA Department, as they related to authorization of medical services for Health Choice members. This position monitors all authorization processes for meeting coordination of care, timeliness standards, cost effectiveness

Assure department efficiency and effectiveness

  • Communicate job expectations to staff

  • Plan, assign, monitor, and appraise employee's job results

  • Maintain, train, orient, mentor and evaluate staff

  • Set example of proper behavior and accountability to employees and serve as a role model for what is expected of a Health Choice employee

  • Monitor phone activity and employee productivity on a regular/consistent basis

  • Ensure that work completed by staff are timely, accurate and complete per policy and procedure

  • Provide ongoing education

Ensure appropriate utilization of services of cost effective, medically necessary care, following Health Choice policy, clinical criteria, contractual requirements and current medical community standards of care:

  • Review and authorize, as appropriate, Prior authorization requests per established formulary and Prior authorization protocol

  • Review all requests not approved by the Prior authorization Technician prior to sending to the Clinical Services Manager

  • Review cases and potential denials with the Clinical Services Manager

  • Research requests not clearly meeting established criteria

  • Notify the Case Management Department of possible referrals

  • Assist the Prior authorization Technicians with the Prior Authorization process

  • Review and approve or forward all Specialty Medication requests to the Clinical Services Manager

  • Collaborate with and be a resource to Health Choice departments, such as Claims, UM, Quality, Disputes/Appeals, Maternal Child Health

Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment while still being valued for your individual strengths Health Choice is the place for you.

Equal Opportunity Employer Minorities/Women/Veterans/Disabled

Qualifications:

Two (2) plus years direct supervisory expereince

Three (3) plus years Medicaid / Medicare experience

Two (2) plus years Prior Authorization / Utilization Review experience

Knowledge of medical terminology


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Prior Authorization Technician Supervisor

Expired Job

Iasis Healthcare