Supervisor, Prior Authorization, RN

Summary/Position Objectives:
Reporting to the Prior Authorization Manager, incumbent will supervise the department work activities in order to ensure that service standards are met and that operations are consistent with the health plan policies, as well as the policies of regulatory agencies. Incumbent assures that all authorization requests are responded to in a professional, competent manner while applying appropriate medical criteria and policies. Incumbent is responsible for overseeing the day-to-day operational activities of the Prior Authorization Department. Assisting with the development and evaluation of programs designed to promote the efficient delivery of Prior Authorization services.


Responsibilities:
Essential Functions:
Supervises, advises and facilitates the ongoing development and education of the prior authorization staff.
Supervises the day to day activities of the prior authorization department, to insure staff work within timelines based on the Health Plan’s policies.
Ensures service standards of the Health Plan are met.
Identifies problem areas and participates in the development and implementation of appropriate corrective action.
Participates in the evaluation of the effectiveness and efficiency of the prior authorization process.
Interfaces with all departments within the health plan to ensure appropriate support for all prior authorization activities.
Oversees the duties of the PA Nurse, assuring that all requests for medical appropriateness use the established criteria hierarchy to determine the medical necessity of the request.
Demonstrates support of the Health Plan’s needs to be cost effective in terms of resources, material and time.
Develop, establish, and maintain a work priority system to ensure daily and heavy workloads are fulfilled.

Secondary Functions:
Acts as a resource for policies, procedures, and operational changes in the Prior Authorization Department.
Assists in the completion of staff evaluations and employee discipline.
Maintains confidentiality of the member’ medical information.
Works in a manner that is not disruptive to peers, supervisors and/or subordinates.
Must maintain regular and acceptable attendance at such level as is determined in the employer’s sole discretion.
Must be available and willing to work such days and hours as the employer determines are necessary or desirable to meet its business needs.
Must be available and willing to travel to such locations and with such frequency as the employer determines is necessary or desirable to meet its business needs. (If travel required.)
REQUIREMENTS
Knowledge and Skills:
Incumbent must have strong team leadership, problem solving, organizational, and time management skills with the ability to work in a fast paced environment. Excellent oral and written communication skills are necessary. The ability to use advanced reason to define problems, collect data, establish fact, draw valid conclusions, and design, implement, and manage appropriate resolution is required. Proficient use of Microsoft Office Suite and common computer and office hardware is necessary. Must be able to work independently and with minimal supervision.

Education and Work Experience:
Current RN or LPN license. Minimum of three years in healthcare industry. Minimum of 2 years Supervisory experience.


Work Environment Qualifications:
Position is a computer station, office environment. Incumbent is expected to sit for extended periods. Incumbent will have one-on-one contact with other employees in a quiet environment where hearing and listening is paramount. Incumbent must generate written work using a computer/keyboard. This position is required to work to project timelines, and at times may deal with significant time pressures. Incumbent is expected to use diplomacy and problem-solving skills to procure data and information from other sources, as well as handle incoming public inquiries.