Prior Authorization & Referrals Manager
Atlanta, GA 30301
- 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.
- 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.