Department Name:
Prior Authorization
Work Shift:
Day
Job Category:
General Operations
Estimated Pay Range:
$46.84 - $78.06 / hour, based on location, education, & experience.
In accordance with State Pay Transparency Rules.
Better Than Ever for Nurses. When we make things better than ever for nurses at Banner Health, we make things better than ever for all of us. This means investing in the holistic health and happiness of our nurses—through better pay, better benefits, better opportunities and a better community
As an Associate Director of Registered Nurse Medical Management, you will
you will be responsible for leading teams of RN Prior Authorization Review Nurses and the LPNs who make up the denial letter writing team. You will also work closely with the Director RN, Medical Directors, non-clinical and clinical team members, and leaders of other departments. Your responsibilities will also include assisting the Director RN with audits for Medicare Advantage plans and commercial insurance plans. Must have case management and prior authorization experience to be considered.
Your work location will be entirely remote. Your workdays will be Monday-Friday often 10-hour days. On call varies but may be required on Saturday when needs arise. This position does require residency in the state of Arizona. If this role sounds like the one for you, Apply today!
Your pay and benefits (Total Rewards) are important components of your Journey at Banner Health. Banner Health offers a variety of benefit plans to help you and your family. We provide health and financial security options, so you can focus on being the best at what you do and enjoying your life.
Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.
POSITION SUMMARY
This position is responsible for the support and implementation of programs and tactics used to influence provider and Plan consumer/beneficiaries’ behaviors in order to achieve right care in the right place at the right time and the appropriate cost. Plans and provides support for health plan consumers/beneficiaries to align with the objectives of triple aim. Plans and provides managerial leadership to team members within the department. This position supervises direct report personnel and participates in selection, orientation, counseling, evaluation and team scheduling. Promotes a collaborative, open and inclusive work environment in a highly matrixed organization. Maintains a depth and breadth of clinical competency and/or managed care knowledge to assess outcomes, provide oversight and coordination related to delivery of Medical Management services.
CORE FUNCTIONS
1. Provides and/or facilitates medical management and/or other related activities and serves as a resource to other team members. Promotes interdisciplinary health plan consumers/beneficiaries’ care planning and supports Care Model.
2. Periodic On-Call availability to address after hour health plan consumers/beneficiaries’ needs related to medical management.
3. Hires, trains, and conducts performance reviews, and directs the workflow for the team. This position is also accountable for participating in the development and implementation of department goals and objectives. Ensures all goals and objectives are met timely and effectively.
4. Evaluates and implements departmental processes to support Strategic Initiatives as determined by Banner Health Network.
5. Serves as a resource and provides leadership assistance to achieve optimal clinical, operational, financial, and satisfaction outcomes. Acts as a consultant within the organization and community.
6. Analyzes data and healthcare trends to gain efficiencies and improve health plan consumers/beneficiaries’ outcomes. Acts as change agent to lead team through necessary modifications of processes, workflows, and/or delegated requirements.
7. Participates in the development of the department budget in conjunction with established goals and objectives. Plays a key role in ensuring budgetary goals are met on an annual basis.
8. Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, and participating in professional societies.
9. This position is facility/entity based, providing leadership within medical management to ensure quality outcomes and resource efficiency. Internal customers include all levels of nursing leadership and team members, medical staff and all other members of the interdisciplinary healthcare team. External customers include physicians, payers, community agencies, provider networks and regulatory agencies.
MINIMUM QUALIFICATIONS
Must possess a strong knowledge of nursing, case management or healthcare related field as normally obtained through the completion of a bachelor's degree or equivalent experience.
Requires current Registered Nurse (R.N.) license in state worked.
Requires extensive knowledge in the areas of case management and utilization management. Must have a working knowledge of hospital operations, medical/nursing staff procedures, hospital and community resources. Requires excellent leadership skills and an ability to interact well across departments, facilities and organizations. Excellent organizational, human relations, and communication skills are required to maintain good rapport and effective working relationships with internal and external customers. In BPA (Banner Plan Administration) setting, requires an understanding of reimbursement methodologies.
PREFERRED QUALIFICATIONS
Related certification(s) such as CCM, Certified Case Manager, MCG Certification(s), RN-BC Registered Nurse Case Manager, CMAC, Case Management Administrator preferred.
Additional related education and/or experience preferred.
EEO Statement:
EEO/Female/Minority/Disability/Veterans
Our organization supports a drug-free work environment.
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