Director, Prior Authorization Non-Clinical

Job description

Position Summary: The role of the Director, Prior Authorization is to manage the prior authorization nurse case managers and support staff (coordinators), professional claims review nurses and UM compliance staff in order to promote quality, cost effectiveness medical care through 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 with Medical Director program goals and objectives; makes staff assignments; develops or assists in the development of related prior authorization and claims policy, 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 processes and workflows, treatment and services delivered to patients; de...