Prior authorization Jobs in Fort myers fl

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management / Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Must Reside in Florida

Shifts will be an 9am - 6pm EST

Position Purpose : Supervises the prior authorization request process for required authorizations to ensure work queue is managed and addressed properly and timely. Supervises day-to-day activities and provides guidance to the authorization team on documenting and resolving all authorization requests and / or issues to ensure accurate and timely documentation for services related to the members healthcare eligibility and access.

• Ensures authorization team’s compliance with contract requirements, policies, procedures, and performance standards.
• Monitors authorization requests inventory to ensure proper resources allocation throughout the day.
• Maintains knowledge of contract requirements, policies, procedures, and performance standards.
• Works with authorization team and senior management to identify opportunities for process and quality improvements within authorization request processes.
• Evaluates authorization team performance and provides feedback regarding performance, goals, and career milestones.
• Provides coaching and guidance to authorization team for SLAs and department productivity goals to ensure accurate and timely documentation for services and improve processing and quality of authorization requests.
• Proactively monitor for organization risks, communicates risks to leadership and develop action plans to mitigate risks.
• Assists with onboarding, hiring, and training authorization team members. Participates in developing job aids, workflows and implements change management strategies.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education / Experience : Requires a Bachelor's degree and 4+ years of related experience. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. Knowledge of medical terminology and insurance preferred.

Pay Range : $61,200.00 - $110,200.00 per year

Centene offers a comprehensive benefits package including : competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act