Job Description

Oversees the day-to-day operation of the Prior Authorization Department and staff assigned to ensure all contract requirements and business

initiatives are completed successfully and timely. Works closely with the CMO and Director of Pharmacy to ensure that the Pharmacy Department

is a highly functioning quality department, characterized by teamwork, cooperation, efficiency, innovation and excellence. Serves as a role model

and mentor for assigned staff

• Implements and maintains an effective prior authorization program that meets the timeliness for the Medicaid and Medicare lines of business. This includes timeliness of denials, denial notifications, both verbal and written, and appropriate documentation and logs.
• Conducts both monthly and quarterly audits in PA to include routine data entry, denials, and closure of authorization.
• Works with Diretor of Pharmacy in oversight responsibilies of PBMs. This includes working with staff to analyze PBM reports to ensure correct adjustication of claims.
• Ensures standardization and consistency in practices, procedures and workflow to improve efficiency and quality.
• Monitors and implements productivity standards and takes necessary action when standards are consistently not met.
• Works with Director of Pharmacy to ensure PA department receives compliance in all assigned areas on reviews for Medicaid and Medicare. Assist in the development and implementation of CAPs for both Medicaid and Medicare when applicalble.
• Other related job tasks or responsibilities as assigned

• Minimum Requirements
  • Experience: Previous prior-authorization experience in a managed care organization. Good communication, organizational, and PC skills required.

• Preferred Requirements

  • Experience: Demonstrated experience managing staff. Demonstrated ability to work in fast pace, multi-tasking team environment while meeting deadlines.
  • Highly skilled in leading significant change efforts and in building strong partnerships with business-line executives.
  • Proficiency in the management of time, flexibility, and influencing colleagues to meet demanding project timelines; developed ability to use various PC software programs: Microsoft Word, Excel, Access, and PowerPoint. Previous project management desired. Strong verbal and written communication skills and ability to form cross functional partnerships to accomplish goals. Strong coaching and interpersonal skills; Ability to cultivate a strong internal culture designed around collaboration, feedback, motivation and accountability

  #LI-AL1



Are you a results-driven leader ready to make a meaningful impact to patients, caregivers, and your community? At Abrazo West Campus hospital, were seeking an innovative and experienced healthcare leader to drive excellence and inspire our team towards exceptional patient outcomes and operational success.

At Abrazo West Campus, we understand that our greatest asset is our dedicated team of professionals. That’s why we offer more than a job – we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include:

• Medical, dental, vision, and life insurance
• 401(k) retirement savings plan with employer match
• Generous paid time off
• Career development and continuing education opportunities
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance

Note Eligibility for benefits may vary by location and is determined by employment status