Utilization Management Supervisor

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing whole-person care to Senior and Medicaid populations, through advanced value-based models. Our provider network is comprised of more than 6,000 health care providers, including primary and specialty care physicians, hospitals and ancillary providers. We have operated in the Arizona market for more than 14 years, based in Chandler, Arizona, and are an affiliate of Heritage Provider Network. As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing cost. The Prior Authorization Supervisor is a non-clinical position, responsible for the direct oversight of the Prior Authorization Representatives and Prior Auth department to ensure regulatory and health plan compliance requirements with AZPC policies and procedures. Through daily management of Prior Authorization workflow and participation in day-to-day activities, ensures all staff provides outstanding customer service, are knowledgeable, and have the ability to assist in coordination of care services that meet or exceed the organization's expectations. The Prior Authorization Supervisor works closely with PA staff, Director of Credentialing and Prior Authorization, as well as the Medical Directors to maintain turnaround time requirements of the contracted Health Plan(s) and internal targets. Routinely interacts with physicians, their office staff, and internal customers. POSITION DUTIES & RESPONSIBILITES Provides direct oversight of all Prior Authorization Representatives by ensuring staff are following Arizona Priority Care organizational and departmental policies, procedures, and rules are followed and enforced consistently and fairly. Manages PA workflow to ensure that standard and expedited requests meet compliance requirements with regulatory and health plan requirements including turnaround time. Manages PTO request for non-clinical staff, department calendar, and payroll review and submission. Conducts annual review (at minimum) and updates Standard Operating Procedures to ensure the team is doing the right thing at the right time for the right health plan, reviewing needed changes with management prior to implementing change with the team. Acts as point of contact for all Prior Authorization questions and/or concerns, understanding when to elevate to management. Participates in project management when new processes impact the Prior Authorization department. Processes all auth modification requests (extensions, provider changes, etc.). Provides back-up support for non-clinical PA Nurse functions when needed to include case preparation to be routed to Medical Director or UM Administrative Reviewer. Processes all administrative denials i.e., out of network and lack of information. Responsible for non-clinical new hire process to recruit, interview, and modify job descriptions as needed, reviewing with management approval. Work with Prior Authorization management to create, modify, and implement training programs for non-clinical and clinical staff. Collaborates with the PA Rep II to provide ongoing training and mentoring all Prior Auth Representatives on customer service standards, job role and responsibilities, and ensures adequate training is provided for new processes including maintenance of proof of training. Performs monthly internal audits of Prior Authorization staff to ensure quality of work being completed and provide constructive feedback and positive reinforcement to each team member with monthly 1:1's. Conducts 90-day and annual performance evaluations and provides positive/constructive feedback along with SMART goals. Perform weekly 1:1's for all new hires for at least 90 days with Prior Authorization management to identify any concerns, questions, trends and create a plan of action to correct any deficiencies. Conducts team huddles to share updates, changes and answer questions. Collaborates with management on quarterly PA team meetings to including preparing agenda, meeting minutes and presentation. Conducts TAT analysis of non-compliant request with identification of trends, barriers and actions/interventions. Collaborates with management on analysis of underutilization review with identification of trends. Demonstrates knowledge with all tasks in PA department such as processes for routine, urgent, accuracy check, report review, etc. Anticipates our customer needs: Understand the wants and needs of all customers, listen for cues and identify how to respond and intervene as needed. Demonstrates the ability to follow through with requests, sharing of critical information and getting back to management, providers, and other individuals in a timely manner. Exceptional prioritization skills; able to juggle multiple projects, team member's needs, and delegate as needed, when appropriate. Is exceedingly efficient and demonstrates exceptional organizational skills. Demonstrates honesty and integrity in everyday activities. Protects privacy for patients, providers and employees; ensures all personal health information is kept confidential. Protects confidentiality of all team members; ensuring all personal and performance related information is kept confidential. Interacts professionally and communicates clearly with staff, other departments, management, providers and members. Lead by example; follow company and department policies/procedures, have a positive attitude, maintain composure during stress, motivate and inspire team members and boost morale. Communicate clearly and succinctly in all written and verbal communication. Exhibit active listening skills to ensure clear understanding of the issue or task at hand. Demonstrate caring, empath, patience, respect and compassion for all team members. Other duties as assigned by the Prior Authorization management. EDUCATION, TRAINING AND EXPERIENCE Highschool diploma or GED – Required. Minimum of 4 years Prior Authorization experience with demonstrated excellent communication, attention to detail and problem-solving skills. Minimum of 2 years in a leadership type role (any level). Knowledge of managed care systems, NCQA and CMS standards. Excellent knowledge of computer applications, including Microsoft Office Suite (Word, Excel, Outlook and Power Point). Demonstrated excellent customer service etiquette skills, orally and in writing. Demonstrated ability to work within a team environment and creatively supervise staff to achieve organizational goals. This role requires 60 days FT in office presence, hybrid options will be available after the 60-day period. #J-18808-Ljbffr