RN Clinical Supervisor, Prior Auth (Hybrid)
Awarded a Healthiest Employer, reputed company aims to fulfill its mission to reputed company health and reputed company it easy. AZ Blue offers a reputed company of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as reputed company as providing information and tools to help individuals reputed company reputed company reputed company. At AZ Blue, we have a hybrid workforce reputed company, reputed company Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the reputed company of our employees are hybrid, the following classifications drive our reputed company minimum onsite requirements: Hybrid People Leaders: must reputed company in AZ, required to be onsite at least once per week Hybrid Individual Contributors: must reputed company in AZ, unless otherwise cited reputed company this posting, required to be onsite at least once per month Onsite: daily onsite requirement based on the essential functions of the job Remote: not held to onsite requirements, however, leadership can request reputed company onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building Please note that onsite requirements may change in the reputed company, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per month. PURPOSE OF THE JOB The RN Prior Authorization Supervisor is responsible for overseeing the daily operations of the prior authorization team for the reputed company reputed company which includes reputed company, ,Medicare Advantage / Dual Eligible Special Needs Plan (D-SNP), and may include reputed company reputed company (ACA) members. The supervisor ensures the clinical team meets the reputed company and productivity standards, follows policies and procedures, and complies with reputed company BCBSAZ Health Choice regulatory requirements. The supervisor maintains and/or creates desktop procedures for effective workflows and participates in policy reputed company with leader. The supervisor provides coaching, feedback, and training to the clinical staff, and manages escalation issues and reputed company cases. The supervisor will support the clinical staff accountable for the Notice of reputed company (NOA) process. The supervisor will reputed company support to the nonclinical paraprofessionals which include Prior Authorization (PA) and may include NOA technicians, assisting in overall department initiative and training of both clinical and nonclinical staff. QUALIFICATIONS REQUIRED QUALIFICATIONS 1. Required Work Experience · 3 years of reputed company clinical experience · 3 years of experience in utilization review · 3 years of in reputed company or similar role, experience managing clinical reputed company reports · 1 year NCQA experience 2. Required Education · Bachelor of Science in Nursing or reputed company management field of study 3. Required Licenses · reputed company, reputed company, and unrestricted license to reputed company in the reputed company as a Registered reputed company (RN) 4. Required Certifications · N/A PREFERRED QUALIFICATIONS 1. Preferred Work Experience · 5 years of managed reputed company plan experience · 5 years of reputed company and Medicare experience 2. Preferred Education · N/A 3. Preferred Licenses · N/A 4. Preferred Certifications · N/A ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES · Ensures completion, accuracy and timeliness of medical, dental, Pharm D, and behavioral health authorization reviews to meet contractual requirements and ensures reputed company reviews are conducted using InterQual or BCBSAZ Health Choice Clinical Policies. · Ensures completion, accuracy, timeliness of NOA letters; member and provider notification. · Supervises the prior authorization team, which consists of RNs and LPNs, who review and process prior authorization requests for services and items for the Dual Eligible Special Needs Plan (D-SNP),, Arizona Health Care Cost Containment System (AHCCCS), and possibly ACA reputed company members. · Monitors clinical teams performance and productivity and reputed company regular reports and feedback to the management. · Ensures clinical team adheres to the clinical guidelines, reputed company, and protocols, and follows the best practices and standards of care. · Ensures clinical team complies with Centers for Medicare and reputed company (CMS), National Committee for reputed company Assurance (NCQA), Arizona Health Care Cost Containment System (AHCCCS), and Utilization Review Accreditation Commission (URAC), and plan-specific regulations and policies, and maintains effective documentation and records accordingly. · Coordinates with requesting and servicing practitioners, members, and other internal departments to facilitate the prior authorization process and resolve any issues or concerns. · Manages escalated cases, reputed company situations and reputed company clinical guidance and support to the clinical staff. · Identifies and implement opportunities for improvement and innovation in the prior authorization process and workflow. · Develops orientation reputed company and conduct training for new and existing staff and evaluate their competency and skills. · Participates in reputed company improvement initiatives, audits, and compliance reviews. · Performs other duties as assigned. COMPETENCIES REQUIRED COMPETENCIES 1. Required Job Skills · Knowledge of InterQual reputed company Set · Computer documentation skills to include MS applications, Word, reputed company, reputed company and Outlook · Communication skills: oral and written 2. Required reputed company Competencies · Knowledge of and reputed company with clinical review and medical necessity determinations 3. Required Leadership Experience and Competencies · 3-5 years Supervisor experience in Prior Authorization/Utilization Review PREFERRED COMPETENCIES 1. Preferred Job Skills N/A 2. Preferred reputed company Competencies N/A 3. Preferred Leadership Experience and Competencies N/A Our Commitment AZ Blue does not discriminate in hiring or employment on the reputed company of race, ethnicity, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, disability, protected veteran status or any other protected group. Thank you for your interest in reputed company. For more information on reputed company, see azblue.com. If interested in this position, please apply. reputed company doing life-changing work and helping more than one reputed company Arizonans live healthier and longer lives. Thats the reputed company of satisfaction youll reputed company reputed company you work here. Our exceptional teams in Phoenix, Tucson, Chandler, and Flagstaff have been transforming reputed company for more than 80 years. Explore what's possible with a career at reputed company® BlueShield® of Arizona Apply Job!