Manager, Prior Authorization Services

SUMMARY

 

The Prior Authorization Manager is responsible for effective operation of the HealthTrans Prior Authorization Services Group.  At the escalation point, the Prior Authorization Manager must assist the Prior Authorization Technicians in ensuring the timely, accurate and effective resolution to prior authorization requests, issues, or concerns, while always working to maintain HealthTrans’ commitment to superior service. In addition, the Prior Authorization Manager is responsible for working with other HealthTrans personnel and departments to prioritize and manage projects, thereby enabling and facilitating the Prior Authorization Technicians work flow. The Prior Authorization Manager will also utilize analytical, negotiation, training, motivation and communication skills, as well as a positive and polite attitude in order to converse with all levels of contacts from the Operations Department to the Clinical P&T Committee to the Senior Executives and outside Healthcare Professionals. These same skills are required in order to translate customer needs and work effectively with other HealthTrans team members.

 

 

JOB DUTIES

 

· Manage the Prior Authorization Technicians and their efforts in the Prior Authorization Group.

· Responsible for all personnel related functions for the department including: hiring, scheduling, training, performance appraisals, budgeting, and termination of the Prior Authorization Technicians.

· Establish guidelines, training and motivational programs that facilitate successful call resolutions that meet all client requirements.

· Prioritize projects and issues within the Prior Authorization Group.

· Implement Clinical Protocols as defined and designed by HealthTrans’ Clinical P&T Committee and our clients.

· Interact with other licensed professionals in support of Prior Authorizations and Utilization Review.

· Participate on cross departemental project teams to ensure successful client implementations.

· Responsible for knowledge of the HealthTrans claims adjudication software and the healthcare transaction industry.

· Maintain documentation / tracking log of open Prior Authorization issues, requests and questions.

· Prioritize, schedule, and coordinate resources in support of new and/or existing requirements within budget and on schedule.

· Assist and/or coordinate the training of all current and new Prior Authorization Technicians. Create and maintain a written training program. 

· Responsible for development and achievement of departmental, and company, short and long term goals and objectives.

· Provide Client level reporting on the Groups efforts and outcomes.

· Review, update, and report on departmental performance metrics.

· Support and participate in the Request for Proposal/Information process.

· Responsible for all shifts in Prior Authorization Group.

· Travel is required when necessary.

· Other duties as assigned.

 

 

EDUCATIONAL REQUIREMENTS

 

· PharmD or BS Pharmacy. Minimum Experience: 1-3 years of pharmacy experience preferred.

 

EXPERIENCE AND SKILL REQUIREMENTS

 

· PharmD/BS Pharmacy: 1 to 3 years experience in a Management position with experience in managing people, projects, and budgets.

· Excellent interpersonal, management, organizational, analytical, planning, presentation, communication, and written skills.

· Experience in designing, implementing and measuring clinical protocols.

· Ability to achieve positive and successful results in a fast paced changing environment.Excellent Microsoft Office skills to include: Word, Excel, PowerPoint, Outlook. 

EXPERIENCE AND SKILLS DESIRED

 

· Experience in a variety of business settings including: retail, mail service, case management and/or hospital setting.

 

ACCOUNTABILITY

 

· To provide client satisfaction and promote positive and effective interdepartmental relationships.

· Successfully balance team and individual responsibilities and willingly assist other employees and departments when required for overall company success.

· Select and use appropriate and professional communication methods to keep others adequately informed.

· Display a positive outlook, a pleasant manner and exhibit tact and consideration when handling internal and external HealthTrans business.

· Be available to support all shifts.

· Train and motivate Prior Authorization Group staff to achieve and excel in their position and career.