Manager, Prior Authorization (Medicaid)

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

The remote work opportunity requires residency and work to be performed within the State of Arizona.

PURPOSE OF THE JOB

This position oversees the non-clinical day-to-day operations of the Prior Authorization Department. Responsibilities include proactive planning, organization and oversight of operations ensuring the highest quality of care and serves are provider in the most efficient manner. The Manager, Prior Authorization Ops focuses on achieving outcomes, meeting and/or exceeding

regulatory standards as it relates to prior authorization.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. Required Experience

At least 5 years customer service experience and/or health care related field

At least 5 years Managerial experience

Previous experience working with Medicare and Medicaid Health Plans preferred

2. Required Education

BSN

3. Required Licenses

Unrestricted and active Arizona RN license

4. Required Certifications

N/A

PREFERRED QUALIFICATIONS

1. Preferred Work Experience

N/A

2. Preferred Education

MSN

3. Preferred Licenses

N/A

4. Preferred Certifications

N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

Monitor and maintain reporting of prior authorization operations and processes, monitor and report department compliance standards to Medical Management and Health Plan Leadership

Implement and develop utilization reports and collaborate with Medical Management to identify trends, develop and implement innovative action plans to improve quality, accuracy and efficiency

Lead and provide oversight for all health plan audits, monitor all department reporting to ensure data is accurate, develop and implement department work plans, collaborate with Medical Management on strategic planning and initiatives, collaborate with Health Plan Leadership and Department Heads

Develop, implement and maintain department policies and procedures, communicate job expectations to staff, oversight of employee evaluations and personnel actions, lead the department in positive communication and team building

Leads the charge in focus and implementation of the organization's culture and strategic plan in a way that aligns to the mission, vision, and values of the organization.

Perform all other duties as assigned

The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements

COMPETENCIES

REQUIRED COMPETENCIES

1. Required Job Skills

Requires excellent writing skills.

Requires demonstrated competence in project management with strong conceptual, communications, design and

organizational skills.

Complete tasks with little supervision

Ability to think analytically and make independent decisions

Ability to manage multiple projects and prioritize work tasks to adhere to deadlines and identified time frames

2. Required Professional Competencies

Must be able to effectively communicate with internal and external customers via telephone and email.

Able to accurately receive information through oral communication.

Able to accurately review data and figures both in hard copy and electronic formats.

Utilize a computer (including but not limited to a mouse and keyboard) and telephone intermittently throughout entire shift, for periods of up to four (4) hours at a time.

Able to accurately sort through data and think through issues in a time-pressured environment.

Able to focus on a specific event or activity for up to four (4) hours at a time without interruption.

Able to maintain a calm and collected presence while addressing the concerns from an internal and external customer

Able to accurately learn and retain new information, knowledge and skills.

Able to efficiently manage multiple tasks, with varying degrees of priority, at the same time.

3. Required Leadership Experience and Competencies

Ability to lead others

PREFERRED COMPETENCIES

1. Preferred Job Skills

N/A

2. Preferred Professional Competencies

N/A

3. Preferred Leadership Experience and Competencies

N/A

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.