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Health Services WellCare - Health Services Management Careers

Prior Authorization Manager Job

Full Job Title: *Prior Authorization Manager

Job Number: 1803348

Location: Phoenix, AZ

Date Posted: 2018-05-25

This position is for Care1st Health Plan, a WellCare Health Plans, Inc. company.

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

Department: Health Services -Medicaid

Reports to: Sr. Director of Field Health Services

Location: E. Camelback Rd, Phoenix AZ 85016

Job Type: Manager / Exempt

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.
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

Technical Skills:
  • Required Intermediate Microsoft Word
  • Required Intermediate Microsoft Excel
  • Required Intermediate Microsoft PowerPoint
  • Required Intermediate Microsoft Outlook
  • Required Intermediate Healthcare Management Systems (Generic)

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Last Updated On: 12/9/2015