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Prior Authorization Manager - RN

    • Job Tracking ID: 512689-583929
    • Job Location: Milwaukee, WI
    • Job Level: Management
    • Level of Education: BA/BS
    • Job Type: Full-Time/Regular
    • Date Updated: September 13, 2017
    • Years of Experience: 7 - 10 Years
    • Starting Date: ASAP
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Job Description:

This position will also serve as a clinical consultant to the iCare staff regarding Medicare and Medicaid guidelines, benefits and coverage issues relating to the prior authorization process.

  1. Supervise and direct the work of the all staff in the Prior Authorization Department. This includes hiring, training, handling employment and performance related matters, performance evaluations, coaching and staff development.

  2. Manage overall work load and work flow in the Department for optimum efficiency, quality, and timely service to internal and external stakeholders.

  3. Have current knowledge of Medicare/Medicaid guidelines, benefits and coverage policies.

  4. Assist Medical Director in PA Department management/supervision functions as requested.

  5. Assist Medical Director in assuring PA Department compliance with required Company and Medicare/Medicaid standards.

  6. Assist Medical Director in achieving yearly financial goals in the PA Department through planning, directing, controlling, implementing, evaluating, monitoring and forecasting as needed to achieve budget and cost of operations.

  7. Work collaboratively and assist in coordinating effort between support departments within the organization.

  8. Establish, prepare, implement, revise and maintain policies, procedures and work flows related to the PA department including ensuring annual review of all policies and IDPs by all PA staff.

  9. Ensure that PA Department Staff is effectively cross trained. Fully participate in iCare’s Compliance Program, including compliance with iCare’s Code of Conduct, policies and procedures, and all applicable Privacy and Security laws.

     

Experience and Skills:

  1. Must be a Registered Nurse, currently licensed and in good standing in the State of Wisconsin.

  2. Two years of related clinical health care experience and 5+ years of work experience in managed care prior authorization. Previous management experience required.

  3. Have knowledge of and familiarity with Medicare and Medicaid program.

  4. A personal vehicle, valid State of Wisconsin motor vehicle operator’s license and conformity with insurance coverage limits are required.

  5. Ability to effectively communicate thoughts, ideas, and information both orally and in writing.

  6. Ability to demonstrate flexibility, set priorities with daily demands and long-term work assignments and projects.

  7. Strong interpersonal skills and ability to effectively interact with members and co-workers from a variety of different backgrounds and experiences in a professional and courteous manner.

  8. Ability to work effectively as a team leader as well as a team member and cooperate in achieving company goals.

  9. Creative problem solving ability to achieve solutions using appropriate methodologies.

  10. Must be able to travel to any location within iCare’s service area.

  11. Demonstrated computer skills including use of Microsoft Windows, Outlook, Excel, Word and ability to use/learn other applications needed in the position.

  12. Ability to work independently with minimal supervision.


 

 
 
 
  • Independent Care Health Plan
  • 1555 RiverCenter Drive, Suite 206
  • Milwaukee, WI 53212
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