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Health Services WellCare - Health Services Management Careers

Prior Authorization Manager Job

Full Job Title: Mgr, Prior Authorization

Job Number: 1805585

Location: Tampa, FL

Date Posted: 2018-08-07

Oversees the day to day operations for prior authorization management activities for multiple markets designed to achieve quality and service driven objectives.

Reports to: Director, Utilization Review

Department: Inpatient Care Management

Location: Tampa, FL

Essential Functions:

  • Manages and optimizes workflows to achieve successful operational and quality outcomes and benefit maximization within the scope of responsibilities.
  • Serves as an instrumental partner with clinicians in monitoring and tracking key performance indicators to include identification of over/under utilization patterns and/or deviation from expected results for assigned area/markets.
  • Monitors processes and procedures to ensure compliance with contractual, regulatory (Federal/State) and accreditation entities.
  • Provides leadership and support to front-line staff and supervisors.
  • Monitors and tracks production and quality driven work products and outcomes to individual performers.
  • Provides guidance for prior authorization management for future expansion and growth efforts.
  • Leads talent management activities to develop and cultivate future leaders.
  • Performs other duties as assigned.
Additional Responsibilities:
    Candidate Education:
    • Required A High School or GED
    • Preferred A Bachelor's Degree in Healthcare or Business
    Candidate Experience:
    • Required 5 years of experience in a call center environment and/or operations environment.
    • Required 1 year experience in leading/supervising others in a healthcare or business focused environment
    Candidate Skills:
    • Intermediate Demonstrated problem solving skills
    • Intermediate Demonstrated interpersonal/verbal communication skills
    • Intermediate Knowledge of community, state and federal laws and resources
    • Intermediate Ability to effectively present information and respond to questions from families, members, and providers
    • Intermediate Ability to work within tight timeframes and meet strict deadlines
    • Intermediate Demonstrated written communication skills
    • Intermediate Ability to lead/manage others
    • Intermediate Ability to effectively present information and respond to questions from peers and management
    • Intermediate Ability to lead/manage others in a matrixed environment
    • Intermediate Knowledge of healthcare delivery
    • Intermediate Knowledge of community, state and federal laws and resources
    • Intermediate Other Demonstrate effective critical thinking and decision making skills
    Licenses and Certifications:
    A license in one of the following is required:
      Technical Skills:
      • Required Intermediate Microsoft Word
      • Required Intermediate Microsoft Excel
      • Required Intermediate Microsoft PowerPoint
      • Required Intermediate Microsoft Outlook
      • Required Intermediate Healthcare Management Systems (Generic)
      Languages:

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        Last Updated On: 12/9/2015