Job Description

*National Jewish Health - Main Campus · Adult Admin Services
Denver, CO
Full Time (40 hours per week), Day Shift, 8:00a - 5:00pm
Posted 12/07/2017
Req # 11095
Position Summary:The Manager of Precertification, Authorization and Utilization Management ensures National Jewish Health patients are seen in the proper clinical environment and that all insurance arrangements are in place prior to care.  This role works closely with the faculty and clinical team to educate the clinical and administrative teams on insurance expectations and to ensure that care is consistent with insurance medical necessity and pre-authorization requirements.
Essential Duties:1.       Manages/supervises and develops an effective staff: providing effective communication, leadership, guidance and resources. Determines staff qualifications and competency: recruits, interviews, selects, hires, trains, orients, mentors, evaluates, coaches, counsels, and disciplines, and rewards.
2.       Translates departmental expectations of service into accountabilities, including communication and financial accountabilities, for staff involved in serving the patients of National Jewish Health. Monitors patient processes to verify compliance to expectations. Communicates success and opportunities to improve.
3.       Establishes and maintains positive working relationships with clinicians, physician leadership, and clinic leadership. Identifies opportunities for service optimization and works to act upon opportunities.
4.       Leads the patient intake, verification, authorization processes to ensure that care is provided in the correct setting with proper authorization and in compliance with regulatory and insurance standards.
5.       Monitors broader National Jewish Health utilization working with contracting, PFS, ancillary areas and clinical teams to avoid unnecessary insurance write-offs or uncompensated services.
6.       Collaborates with Patient Financial Services, Administrative services, Nursing and Faculty to ensure that National Jewish Health is aware of and operates in accordance with insurance front-end requirements.
7.       Monitors UM workflow to assure timely authorizations and Quality Assurance of clinical calls and staff work. Provides appropriate feedback to staff and management.
8.       Develops and produces routine and ad hoc reporting to support departmental and institutional strategic goals.
Other Duties:None
Competencies:1.       Accountability:  Accepts full responsibility for self and contribution as a team member; displays honesty and truthfulness; confronts problems quickly; displays a strong commitment to organizational success and inspires others to commit to goals; demonstrates a commitment to National Jewish Health.
2.       Attention to Detail:  Accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.  Setting high standards of performance for self and others; assuming responsibility and accountability for successfully completing assignments or tasks; self-imposing standards of excellence rather than having standards imposed.
3.       Building a Successful Team:Using appropriate methods and a flexible interpersonal style to help build a cohesive team, aligns vision with shared values, manages change and encourages innovation.
4.       Coaching and Teaching Others:Providing timely guidance and feedback to help others strengthen specific knowledge/skill areas needed to accomplish a task or solve a problem.
5.       Collaboration/Teamwork: Cooperates with others to accomplish common goals; works with employees within and across his/her department to achieve shared goals; treats others with dignity and respect and maintains a friendly demeanor; values the contributions of others.
6.       Managing Conflict:   Dealing effectively with others in an antagonistic situation; using appropriate interpersonal styles and methods to reduce tension or conflict between two or more people. Addresses conflicts by focusing on the issues at hand to develop effective solutions when disputes or disagreements occur; helps others resolve conflicts by providing impartial mediation when needed.
7.       Problem Solving:  Uses issue identification, data relation and comparison, pattern recognition and information gathering to create analyses and make recommendations.
Supervisory or Managerial Responsibility:Manages 5-15 employees
Core Values:
1.       Be available to work as scheduled and report to work on time.
2.       Be willing to accept supervision and work well with others.
3.       Be well groomed, appropriately for your role and wear ID Badge visibly.
4.       Be in compliance with all departmental and institutional policies, the Employee Handbook, Code of Conduct and completes NetLearning by due date annually.
5.      Fosters an inclusive workplace where diversity and individual differences are valued and leveraged to achieve the vision and mission of the institution.
6.       Adheres to safe working practices and at all times follows all institutional and departmental safety policies and procedures.
7.       Wears appropriate PPE as outlined by the infection control policies and procedures.
8.       Demonstrates compliance with all state, federal and all other regulatory agency requirements.
Minimum Qualifications
Education:Bachelor's Degree required, Healthcare Administration preferred.
Work Experience:A minimum of two (2) years of recent and related experience in healthcare insurance precertification/utilization management required.  A minimum of three (3) years recent leadership or management experience required.  
Special Training, Certification or LicensureColorado RN license preferred.

Application Instructions

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