Director, Prior Authorization Non-Clinical

Job description

Position Summary: The role of the Director, Prior Authorization is to oversee the prior authorization non-clinical staff members, primarily coordinators in order to promote quality, cost effectiveness intake and review of pre-certification referrals to ensure strict adherence to all UM policies and procedures within the affiliated medical groups for which this position has oversight. The Director coordinates, plans and manages staff activities; develops and maintains efficient work processes to meet compliance and customer service KPIs; adheres to and supports Medical Director program goals and objectives; makes staff assignments; develops or assists in the development of related prior authorization policies, incorporating current literature and professionally recognized standards; develops or assists in development and implementation of policy and plans for effective patient centered utilization management; together with the medical director, interprets and administers pertinent laws; through direct and indirect contact, evaluates staff and determines the quality of their work efforts; develops and/or implements effective ongoing programs to measure, assess and improve quality of...