Manages the day-to-day non-clinical authorization operations activities, including development and monitoring of internal processes, coordinating activities between the clinical and non-clinical staff, and managing support functions to facilitate efficient non-clinical authorization operations. Makes recommendations on operational improvements for the department. Works under general direction.

What We Provide

Referral bonus opportunities

Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays

Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability

Employer-matched retirement saving funds

Personal and financial wellness programs

Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care

Generous tuition reimbursement for qualifying degrees

Opportunities for professional growth and career advancement

Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

Manages the implementation and operational management of the Authorization Operations Teams -policies and procedures to ensure compliance with DOH and CMS guidelines. Oversees the development, utilization, and evaluation of internal processes to ensure timeliness, customer satisfaction, efficient operations, and accurate and timely resolution for all complaints and issues.

Acts as subject matter expert to internal staff and external Provider staff regarding authorization related requests and inquiries. Ensures that utilization management activities and operations are in compliance with federal, state and local health care regulations and standards of accrediting organizations; oversees the periodic review and audit to ensure compliance with program policies, state and federal regulations.

Evaluates all relevant policies, procedures, and operational procedures; develops and implements revised plans, as appropriate. Collaborates with management to ensure adherence to all regulations, policies and guidelines.

Directs investigations related to member complaints, concerns, or challenging member issues. Implements and manages workflow procedures and systems for an efficient and timely operation that is responsive to customers (members, caregivers, providers) and operational needs. Troubleshoots difficult customer service issues, facilitates problem resolution and directs staff in addressing and resolving day-to-day operational issues.

Assists management team in the development of long and short -range objectives for department, which includes transitions, system and operational rollouts and coordination of non-clinical support functions across teams

Provides input to the Education and Quality department regarding training needs for new initiatives. Participates in the overall planning, implementation and evaluation of such programs. Provides training to staff as needed.

Works with management to develop and implement strategies and actions to improve the quality of the team’s performance, which includes participation in workflow reengineering, process improvement, risk mitigation and computer application development activities.

Monitors adherence to regulatory and enterprise standards to ensure compliant operations and department’s readiness for internal and external audits

Analyzes business operations, , utilization and schedules; contributes to systems design and implementation; and develops standards to measure, maintain and maximize efficiencies and meet operational needs.

Performs all duties inherent in a managerial role. Ensures effective staff training, evaluates staff performance, provides input for the development budget, and hire, promotes, and terminates staff and recommends salary actions as appropriate, as well as maintains business continuity preparedness and contingency planning for the department.

Participates in special projects and performs other duties as assigned.

Qualifications

Education: Bachelor's Degree in Business, Healthcare or other related industry, or the equivalent combination of work and experience required

Master's Degree in Business, Healthcare or other related industry preferred

Work Experience: Minimum six years progressive management experience, preferably in a customer service or health care environment; including a minimum of two years in a managed care/Health Maintenance Organization (HMO) organization required

Minimum two years managerial experience in management care required

Experience with writing and implementing program level policy and procedures and workflows required Proficient in Personal Computers applications, including Microsoft Word and Excel required Knowledge of medical terminology, and /or insurance terminology required

Strong knowledge of operations of manual and automated office systems and procedures required

Strong knowledge of third-party payer requirement for reimbursement preferred

Strong operational skills with attention to detail required

Pay Range

USD $77,200.00 - USD $96,500.00 /Yr. About Us

VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We’re one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.