Supervisor, Prior Authorization - Flexible Remote

Company: Fallon Community Health Plan
Location: Worcester
Posted on: March 20, 2023

Job Description:

Supervisor, Prior Authorization - Flexible RemoteUS-MA-WorcesterJob ID: 7230Type: Full Time# of Openings: 1Category: OtherFallon Health - Corp HQOverviewThe Supervisor, Prior Authorization will be required to come into our Worcester office 1 to 2 days/week About Fallon Health:Fallon Health is a mission-driven not-for-profit health care services organization based in Worcester, Massachusetts. For 45 years we have been improving health and inspiring hope in the communities we serve. Committed to caring for those who need us most, we pride ourselves on providing equitable access to coordinated, integrated care for our members with a special focus on those who qualify for Medicare and Medicaid. We also serve as a provider of care through our Program of All-Inclusive Care for the Elderly (PACE). Dedicated to delivering high quality health care, we are continually rated among the nation's top health plans for member experience and service and clinical quality. Brief Summary of Purpose:The Supervisor is accountable for performance of assigned coordinators, identifying improvement opportunities of FCHP's business processes, as well as, lead and model FCHP's culture.Escalation point for all coordinators; supporting & ensuring resolution of issues.Coaching coordinators to performance expectations; recommending opportunities for process changes as neededAnalyze compliance and quality performance, identifying trends, and drive improvementsRespond to internal and external inquiries and complaints, identifying root cause, and following through on short-term and long-term resolutions.ResponsibilitiesJob Responsibilities:Demonstrate professional management/ leadership behaviors that cultivate a positive and productive work environment.Performance Manage assigned coordinators, ensuring delivery of goals and adherence to business practices and policies.Monitors and coaches staff to deliver on compliance, quality, and expectations.Day to day supervision of the administrative processes and procedures.Provide feedback and maintain appropriate documentation including annual performance reviews.Consistently monitor team to proactively identify potential problems and with guidance ensures appropriate parties are engaged through to resolution.Use and promote Company recognition programs and understand the direct correlation between recognition and retention.Take escalated calls and complete necessary follow-up.Research complaints in order to ensure satisfaction and retention. Participate in the recruiting and interviewing process. Write routine reports and correspondence.Understand compliance and quality requirements, develop, and present reports, and recommend enhancements to drive results.Support training for new & experienced coordinators.Represent the department as assigned.Schedule and follow through on departmental management practices, such as team meetings, daily huddles, etc.Special projects/other duties as assigned by Management.---QualificationsEducation:College degree (B.S. or B.A.) or equivalent strongly preferred Experience:3+ years' experience in a related position, preferably in health careSupervisory experienceDemonstrated leadership skills; ability to coach, motivate, delegate, communicate, and reward effectivelyUnderstands products, services, and performance standardsAbility to work under pressure and remain flexible to changing schedules and demandsAbility to apply common sense, understanding and problem solvingComfortable gathering and reviewing data, analyzing data, developing recommendations, and reporting resultsExperienced with MS Office Suite, Windows 10Learns new systems with ease; experience with QNXT & TruCare preferred. Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. Fallon Health Vaccination Requirements:To protect the health and safety of our workforce, members and communities we serve, Fallon Health now requires all employees to disclose COVID-19 vaccination status. As of 2/1/2022 all roles not designated as "Remote" require full COVID-19 vaccination and Fallon Health will obtain the necessary information from candidates prior to employment to ensure compliance. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment. PM16 PI208412732

Keywords: Fallon Community Health Plan, Worcester , Supervisor, Prior Authorization - Flexible Remote, Other , Worcester, Massachusetts