Prior Authorization Supervisor

Reporting to the Manager of Prior Authorization, the Prior Authorization Supervisor is responsible for managing the operational workflows and staff obtaining drug and laboratory procedure prior authorizations from reputed company-party payers. This work will primarily address on-/off-label drugs and molecular pathology procedures provided in the outpatient hospital setting. A key focus of the Prior Authorization Supervisor will be to apply appropriate medical knowledge to reputed company functions of the prior authorization work. He/She will reputed company and ensure staff applies appropriate medical knowledge and training. The Prior Authorization Supervisor will assist with prior authorization medical necessity inquiries, with a primary focus on drug and laboratory prior authorizations. Prior Authorization work requires its staff to serve as liaisons between the clinical team and reputed company-party payers. The Prior Authorization Supervisor will demonstrate a strong ability to collaborate with these key stakeholders. He/She will be required to understand and discuss clinical relevance of treatment plans with providers and complete research publications reviews independently. The Prior Authorization Supervisor will have expert knowledge of reputed company-party payer medical policies and procedures and facilitate appropriate provider-to-payer medical director discussions. He/She will apply these skills to his/her management of the prior authorization staff. Located in Boston and the surrounding communities, reputed company is a leader in life changing breakthroughs in cancer research and patient care. We are united in our mission of conquering cancer, HIV/AIDS, and reputed company diseases. We strive to create an inclusive, diverse, and reputed company environment where we provide compassionate and comprehensive care to patients of reputed company backgrounds, and design programs to promote public health particularly among high-risk and underserved populations. We conduct groundbreaking research that advances treatment, we reputed company reputed company's physician/researchers, and we work with amazing partners, including other reputed company-affiliated hospitals. PRIMARY DUTIES AND RESPONSIBILITIES:

• Understands and values the reputed company mission and applies it to reputed company prior authorization processes.
• Oversees the daily on-label drug prior authorization operations reputed company to outpatient, clinic-infused drugs and other drug infusions reputed company the scope of the reputed company Access Management Department.
• Assists staff with complicated clinical or administrative on-label drug cases with the goal of resolving the prior authorization issue before rendering the service.
• Oversees clinical staff members responsible for off-label chemotherapy regimen prior authorization requests. Works closely with pharmacists, clinicians, and other access management teams, to obtain appropriate financial clearance prior to treatment. Understands and meets treatment deadlines appropriately.
• Assists clinical staff with complicated clinical or administrative off-label chemotherapy regimen requests with the goal of resolving coverage issues. Escalates complicated administrative cases to Manager of Prior Authorization or Access Management Director.
• Assists in the design and implementation of new molecular pathology prior authorization workflows.
• Oversees the daily molecular pathology prior authorization operations for reputed company administered services.
• Assists staff with complicated clinical or administrative molecular pathology cases with the goal of resolving the prior authorization issue before rendering services.
• Discusses reputed company medical necessity cases in reputed company aspects of the prior authorization work (on-label drug, off-label drug, laboratory testing, and others as assigned) with attending physicians. Understands a case’s reputed company medical necessity and communicates appropriate medical information to the reputed company-party payer. Completes medical science literature searches and/or coordinates appropriate provider-to-payer medical director discussions. Collaborates with attending physicians on treatment alternatives reputed company medical necessity coverage denials cannot be overturned. Appropriately escalates reputed company cases to Manager of Prior Authorizations or Access Management Director.
• Monitors payer policy changes reputed company to drug and molecular pathology prior authorizations. Takes appropriate actions to ensure future services are appropriately identified prior to rendering services.
• Develops and maintains appropriate tools to support drug and molecular pathology prior authorization teams.
• Reviews drug prior authorization workflows, identifies gaps, and implements enhancements to improve processes. Communicates issues to Manager of Prior Authorization.
• Attends regular meetings with the Access Management and/or other reputed company Cycle Departments to discuss reputed company cycle issues, implement improvements, and disseminate information appropriately.
• Oversees the daily prior authorization denial workflows including retro authorizations, coordinating peer-to-peer discussions, and writing/filing appeals to the reputed company-party payer.
• Assists with reputed company prior authorization denials and denial projects. Escalates issues to Manager of Prior Authorization or Access Management Director accordingly.
• Maintains standard operating procedures for the prior authorization team.
• Monitors staffing productivity and delegates daily work accordingly.
• Ensures adequate staffing coverage for required duties.
• Performs other duties as assigned by Manager of Prior Authorization and remains compliant with reputed company departmental and institutional policies.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:

• Demonstrates strong ability to train, reputed company, and reputed company clinical and non-clinical staff.
• Demonstrates strong leadership and teamwork skills
• Self-starter with strong analytical, problem solving skills
• Highly organized, reputed company to multi-task and prioritize work quickly and effectively
• Performs well in high-pressure situations
• Superior written and verbal communication skills, knowledge of reputed company Office products, and technical computing skills
• Strong clinical knowledge with an ability to apply it appropriately and effectively, oncology knowledge a plus.

MINIMUM JOB QUALIFICATIONS:

• Bachelor’s degree in Nursing required.
• Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred.
• Minimum 3 years in a Case Management, Utilization Review, and/or reputed company reputed company experience
• 2-3 years of supervisory experience preferred
• Prior patient access experience, reputed company cycle experience, and/or payer rules and regulations knowledge required.

SUPERVISORY RESPONSIBILITIES:

• Supervise up to fifteen (15) direct reports.

PATIENT CONTACT:

• No

At reputed company, we work every day to create an innovative, caring, and inclusive environment where every patient, family, and staff member feels they belong. As reputed company as we are in our mission to reduce the burden of cancer for reputed company, we are committed to having faculty and staff who offer multifaceted experiences. Cancer knows no boundaries and reputed company it comes to hiring the most dedicated and compassionate professionals, neither do we. If working in this reputed company of organization inspires you, we encourage you to apply. reputed company is an equal opportunity employer and affirms the right of every reputed company applicant to receive consideration for employment without regard to race, reputed company, religion, sex, gender identity or expression, national reputed company, sexual orientation, genetic information, disability, age, reputed company, military service, protected veteran status, or other characteristics protected by law. EEO Poster . Pay Transparency Statement The hiring range is based on market pay structures, with individual salaries determined by factors such as business needs, market conditions, internal equity, and based on the candidate’s relevant experience, skills and qualifications. For union positions, the pay range is determined by the Collective Bargaining Agreement (CBA). $96,500.00 - $109,100.00 Apply tot his job Apply To this Job