RN Manager, Prior Authorization & Referrals

Location: Wisconsin-Milwaukee - Wauwatosa
Duration: Full Time
Job ID: 1164786 (22078450)
Company: ProEnlist
Contact: April Estes    Call: 7204392609
Job Posted: 04/28/21

RN Manager, Prior Authorization & Referrals - 1164786 (22078450)

About the Company: 
A Fortune 500 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government sponsored healthcare programs, focusing on underinsured and uninsured individuals.  Many receive benefits provided under Medicaid, including the State Children's Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and Long Term Care (LTC), in addition to other state-sponsored/hybrid programs, and Medicare (Special Needs Plans).  

The Company operates local health plans and offers a range of health insurance solutions.  It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health management, care management software, correctional healthcare services, dental benefits management, in-home health services, life and health management, managed vision, pharmacy benefits management, specialty pharmacy and telehealth services.


Position Overview:
Oversee day to day functions of the call center that provides preauthorization and referral services to physicians for plan members.


Responsibilities: 

  • 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 ongoing communication between utilization management staff and contracted providers.



Qualifications:
Education/Experience:

  • 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.



Benefits: 
The company offers more than just medical insurance. They pay most of your benefits costs and in some cases – they pay 100 percent. Most of the benefits not covered by the company are paid with pre-tax payroll deductions. 

  • Health insurance
  • Dental insurance
  • Vision insurance
  • Flexible spending accounts (includes health care, dependent care mass transit reimbursement)
  • Short- and long-term disability insurance
  • Basic Life insurance
  • Supplemental AD&D
  • Supplemental life insurance
  • Wellness Program
  • 401(k) retirement with company match
  • Employee stock purchase plan
  • Vacation, Personal and Sick time
  • Paid Company Holidays
  • Employee Assistance Program (EAP)
  • Training and Learning Opportunities
  • Tuition Reimbursement/Educational Assistance
  • Service Awards
  • On-site fitness center or discount at local fitness centers (most locations)
  • Discounts for select local and national products and services, including cell phones, computers and more
  • Other amenities may be available, but vary by location