Manager, Authorization - 25-163

PriMed Management Consulting•Aliso Viejo, CA

13h•$124,000 - $154,000

About The Position

We’re delighted you’re considering joining us! At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members. Join Our Team! Hill Physicians has much to offer prospective employees. We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction. DE&I Statement: At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are. We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right! Job Description: Provide department management for all regions through leadership with a focus on appropriate member utilization management corresponding to member need, medical necessity, and benefit plan coverage, resulting in optimal member outcomes.

Requirements

Active unrestricted California Licensure: Registered Nurse (RN)
Master’s degree preferred.
Minimum of five years management experience, preferably two years in managed care environment.
Excellent leadership, organizational, and communication skills.
Able to prepare and deliver presentations to varying audiences.
Experience with addressing large groups with confidence.
Self-motivated with the ability to work independently.
Proficient with MS Office: Outlook, Word, PowerPoint, and Excel.

Nice To Haves

Familiar with “Lean” methodology desired.
Experience with Epic and specifically Tapestry, preferred.

Responsibilities

Provide oversight of and accountability for the implementation and documentation of medical management policy and process.
Ensure consistent functions and policy at all sites.
Assure necessary support to clinical and non-clinical personnel to maximize efficiency and support good decision making.
Manage the prospective, concurrent and retrospective review of prior authorization requests and ensure performance and regulatory standards are met.
Manage staff production and overall inventory to ensure turnaround times are meeting department and regulatory goals.
Identify system issues based on analysis of trends and implement corrective actions as appropriate.
Monitor and adjust staffing needs based on production goals, authorization volume, and authorization complexity.
Develop, review and analyze HRM reports to effectively manage outcomes in accordance with organizational department goals.
Serve as liaison for health plans, physician offices, and ancillary vendors.
Serve as a resource for physicians, providers, members, and staff.
Assure that department functions are integrated appropriately into company operations.
Supervise the administration of Medical Management Teams and support the clinical initiatives.
Identify and resolve administrative issues.
Represent Health Resource Management on inter-departmental committees as appropriate.
Provide ongoing training and education to staff.
Have a presence in both San Ramon and Sacramento offices.
Other duties as assigned.