Prior Authorization & Referrals Manager

Atlanta, GA 30301

Posted: 08/22/2018 Category: Registered Nurse Job Number: 28926

Description:
  • Oversee day to day functions of the call center that provides preauthorization and referral services to physicians for plan members.
  • Oversee preauthorization nurses and referral specialists in their day to day activities including management of talk times, service levels, abandonment rate, and other key quantitative/qualitative factors.
  • Develop, implement and maintain compliance, policies and procedures regarding medical utilization management functions.
  • Promote compliance with federal and state regulations and contractual agreements.
  • Review analyses of activities, costs, operations and forecast data to determine progress toward stated goals and objectives.
  • Compile and review multiple reports on work function activities for statistical and financial tracking purposes to identify utilization trends and make recommendations to management.
  • Facilitate on-going communication between utilization management staff and contracted providers.


Education/Experience:
  • Bachelor s degree in related field or equivalent experience.
  • 4+ years of nursing experience.
  • Call center/customer service experience and working knowledge of call center technologies, data, and reporting.
  • Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.
  • License/Certification: RN license.

For more information on this position, please contact our office at 877-782-3334.

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