It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

Responsible for the daily supervision and operations of the Prior Authorization Specialists. Develops training, trains staff, assigns work, implements policies and procedures, and resolves complex issues to ensure accurate and timely management of prior authorization requests. Maintains compliance with state and federal requirements. Performs quality assurance audits. Implements and monitors productivity and efficiency reporting and adjusts workflows/staffing as needed. Supports the Director in day to day operations and focused initiatives. Functions as the liaison between providers and Plan staff as it relates to authorizations.

Our Investment in You:

* Full-time remote work

* Competitive salaries

* Excellent benefits

Key Functions/Responsibilities:

* Supervises all activities of the Prior Authorization Specialists.

* Participates in staff hiring, work allocation and scheduling, development and delivery of training, professional development, performance management, and related supervisory functions.

* Monitors department processes through monitoring the processing of prior authorization requests and conducting and reporting on results of staff audits.

* Monitors and evaluates the quality, timeliness and accuracy of the Prior Authorization Specialists' work.

* Under the direction of the Director of Utilization Management Operations, develops and uses metrics and management reports to monitor staff productivity and efficiency.

* Maintains adequate reporting to assure compliance with all departmental standards and policies. Collaborates with Inpatient Admissions, Pharmacy, and Care Management Teams.

* Collaborates with other department management in the planning, development, and implementation of department specific and cross-functional initiatives and projects.

* Collaborates with Customer Care Department to assure consistent response to provider inquiries related to prior authorizations.

* Responsible for creating and maintaining accurate, consistent, updated departmental Policies, Procedures, workflows and related training manuals.

* Utilizes critical thinking skills to identify process issues and problems, and recommends and implements solutions.

* May identify workflow and systems improvements to enhance UM's ability to monitor, document, and improve key department performance indicators.

* Provides high level of service and satisfaction to internal and external customers.

* Other functions as required to support departmental activities.

Supervision Exercised:

* Manages 8-10 staff.

Supervision Received:

* General supervision is received weekly.

Qualifications:

Education:

* Associate's degree in Healthcare, Nursing, or a related area or equivalent relevant work experience is required.

Experience:

* Minimum of 5 years progressively responsible cross-functional experience in health care.

Preferred/Desirable:

* Prior Authorization supervisory experience preferred.

* Experience with Medicaid recipients and community services.

* Experience with FACETS, Jiva, or other healthcare database.

Certification or Conditions of Employment:

* Pre-employment background check.

Competencies, Skills, and Attributes:

* Ability to train, lead and direct others

* Ability to interact with all levels of the organization as well as external contacts.

* Proficiency in the use of Jiva and/or other UM software.

* Ability to successfully plan, organize and manage projects.

* Ability to meet deadlines, multi-task and use appropriate judgment to solve day to day issues.

* Ability to adapt with complex changes within the industry.

* Excellent oral and written communication and interpersonal skills.

* Strong organizational and time management skills.

* Able to work in a fast paced environment and multi-task.

* Strong working knowledge of Microsoft office products including Word, Excel, and Outlook.

* Detail oriented with strong analytical and problem solving skills.

* Knowledge of process improvement techniques.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.