Job Information
VNS Health Director of Authorization Operations in Manhattan, New York
OverviewDevelops, implements and directs the VNS Health Plans non-clinical authorizations. Directs the development and implementation of department policies, procedures, workflows and internal auditing, in order to ensure the accurate and timely resolution of authorization, activities. Ensures adequate staffing and training to meet all regulatory requirements and maximize provider and member satisfaction. Develops and monitors department budget based on member enrollment forecasts and network plan. Identifies and evaluates new technologies and/or services to enhance Program performance in collaboration with delegated entity and VNS Health Plans IT. Works under general direction.
Compensation Range:$122,300.00 - $164,000.00 Annual
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
Collaborates with VNS Health Plans operations leadership to plan and execute business processes that support authorization accuracy and timeliness.
Designs, develops and implements authorization policies, procedures and workflows to ensure efficient customer service while meeting VNS Health Plans strategic objectives. Identifies areas of improvement, focusing on service and quality while reducing/maintaining costs. Recommends improvements and leads implementation.
Directs the operations of the VNS Health Plans administrative authorization and medical and DME supply ordering teams. Determines direct and contracted staffing levels needed to meet the department’s operational, regulatory and quality goals.
Oversees the non-clinical authorization activities for the TOTAL and MLTC Health Plan products.
Establishes and oversees service standards for the authorization department. Ensures the department has the appropriate resources to meet these standards, and ensures that all activities and escalations are handled with responsiveness and consistency, as well as compliance with VNS Health Plans standards.
Oversees staff scheduling and productivity to ensure prompt distribution and responses to requests during normal operating hours.
Oversees the orientation and training of the department’s staff. Monitors department performance to identify areas for ongoing/refresher staff education. Ensures that staff members have accurate and clear information to foster effective communications with staff and providers.
Identifies and summarizes sources of complaints and inquiries; develops plans to improve satisfaction and staff efficiency, including accurate and timely auth processing, emails, faxes and regulatory letter generation.
Oversees department communication and information systems activities; ensures that required reports are developed, generated, and distributed in an accurate and timely manner.
Identifies and evaluates new technologies and/or services to enhance Plan performance, and recommends appropriate uses. Ensures the effective installation and maintenance of new technologies and/or services to minimize disruptions.
Collaborates with cross-functional management team to ensure seamless communication for providers and members that require authorizations and supply ordering. Ensures that any problems that arise are resolved in an effective and timely manner.
Performs all other duties inherent in a senior managerial role. Approves staff training, hiring, promotions, terminations, and salary actions. Prepares and ensures adherence to department budget.
Participates in special projects and performs other duties as assigned.
Qualifications
Education:
Bachelor's Degree in business administrative, health administration, human services or the equivalent work experience required
Master's Degree in same disciplines preferred
Work Experience:
Minimum of seven years progressive experience in a comprehensive service delivery, health care, and/or health insurance setting required
Minimum of three years experience in a managerial role required
Knowledge of Medicare/Medicaid authorization processing rules and regulations required
Strong interpersonal and analytical skills required
Working knowledge of computer-based systems software, including Microsoft windows software (Word, Excel, and Access) required
Experience with health care provider relations preferred
CAREERS AT VNS Health
The future of care begins with you. Together, we will revolutionize health care in the home and community. When you join VNS Health, you become a part of something bigger. For generations, we’ve been a recognized leader and innovator in patient-centered and community-focused health care. At VNS Health, you’ll have the opportunity to meaningfully impact lives. Including yours. Discover your next role at VNS Health.