Manager, Prior Authorization & Referrals (1164786)
Position Purpose: Oversee day to day functions of the call center that provides preauthorization 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.
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.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.