The Sr. Manager, Prior Authorization is primarily responsible for providing leadership to a team accountable for ensuring department compliance with all Federal and State regulations concerning Prior Authorizations. Work with cross functional departments to guarantee compliance. Participate in client and regulatory audits of Prior Authorizations. Areas of responsibility include case Turnaround Times (TAT), Independent Review Entity (IRE) submissions, Chapter 18 compliance, State Regulatory oversight, outbound calls and reporting on advocate errors tracking and trending.
- Responsible for successful maintenance, reporting, analyzing, and communication of performance surrounding Prior Authorization programs.
- Proactively improve processes and procedures, streamline work flow, automate manual processes, drive new projects which improve service levels, increases ESI’s Scripts’ value, and ensure success in TAT and Performance Guarantee (PG) compliance.
- Build relationship and maintain working communication with cross functional departments and key clients in aligning with all requirements, current and future.
- Manage team of direct reports, responsible for performance evaluations, providing feedback, planning career path.
- Additional projects, travel or activities as assigned.
- Bachelor’s degree in Healthcare, Business or related field or 14-18 years equivalent experience
- 8-12 years relevant experience in business requirements analysis or development in an operations environment
- Knowledge of Coverage Review Department programs and platforms preferred
- Thorough knowledge of ESI’s systems and platforms preferred
- Demonstrated strategic and business acumen
- Demonstrated knowledge of lean methodologies and implementing continuous improvement initiatives
- Six Sigma certification preferred
- Demonstrated leadership skills with experience managing a large, high volume work group
- Ability to build relationships at all professional levels-within immediate team and with cross functional departments
- Excellent communication (oral and written), presentation, project management, and analytical skills
- Willingness to work a flexible schedule to accommodate business requirements
- Proficient knowledge of MS Office software; specifically Excel
Job CategoryClient ServicesPrimary LocationUnited States-Washington-Liberty LakeWork LocationsLiberty Lake, WA - 23102 E Appleway Ave23102 E Appleway AveLiberty Lake99019
ScheduleFull-timeShift1st ShiftEmployee StatusRegularTravelNoWork From Home?No
Internal ID: REQ20008109