Manager, Prior Authorization & Referrals (RN)

Location: Atlanta, GA, United States
Position Purpose: Oversee day to day functions of the call center that provides pre-authorization and referral services to physicians for plan members.
  • Oversee preauthorization nurses and referral specialists in their day to day activities including management of talk times, service levels, abandonment rate, and other key quantitative/qualitative factors
  • Develop, implement and maintain compliance, policies and procedures regarding medical utilization management functions.
  • Promote compliance with federal and state regulations and contractual agreements.
  • Review analyses of activities, costs, operations and forecast data to determine progress toward stated goals and objectives.
  • Compile and review multiple reports on work function activities for statistical and financial tracking purposes to identify utilization trends and make recommendations to management.
  • Facilitate on-going communication between utilization management staff and contracted providers.

  • Bachelor’s degree in related field or equivalent experience.
  • 4+ years of nursing experience.
  • Call center/customer service experience and working knowledge of call center technologies, data, and reporting.
  • Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff. 

License/Certification: RN license.
April A. Estes
Senior Recruiter
720-439-2609 Direct 

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