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Job Details

Mgr Prior Authorization

Company name
Wellcare

Location
Tampa, FL

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Profile

Mgr, Prior Authorization','1803431','Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans to families, children, seniors and individuals with complex medical needs. WellCare is a Fortune 500 company, and in 2018, was recognized as a Fortune �World�s Most Admired Company,� ranking in the top five among the health insurance and managed care industry�a testament to the hard work and dedication of the company�s nearly 9,000 associates who each day live WellCare�s values and deliver on its mission to help its members live better, healthier lives. The company serves approximately 4.4 million members nationwide as of Dec. 31, 2017. For more information about WellCare, please visit the company's website at www.wellcare.com.','!*!Oversees the day to day operations for prior authorization management activities for multiple markets designed to achieve quality and service driven objectives.

Reports to:   Sr, Dir. UM Strategy

Department: HS- Outpatient Services

Location:      Tampa, FL.Essential Functions:

Manages and optimizes workflows to achieve successful operational and quality outcomes and benefit maximization within the scope of responsibilities.

Serves as an instrumental partner with clinicians in monitoring and tracking key performance indicators to include identification of over/under utilization patterns and/or deviation from expected results for assigned area/markets.

Monitors processes and procedures to ensure compliance with contractual, regulatory (Federal/State) and accreditation entities.

Provides leadership and support to front-line staff and supervisors.

Monitors and tracks production and quality driven work products and outcomes to individual performers.

Provides guidance for prior authorization management for future expansion and growth efforts.

Leads talent management activities to develop and cultivate future leaders.

Performs other duties as assigned.

','!*!Candidate Education:

Required A High School or GED

Preferred A Bachelor's Degree in Healthcare or Business Candidate Experience:

Required 5 years of experience in a call center environment and/or operations environment.

Required 1 year experience in leading/supervising others in a healthcare or business focused environment Candidate Skills:

Intermediate Demonstrated problem solving skills

Intermediate Demonstrated interpersonal/verbal communication skills

Intermediate Knowledge of community, state and federal laws and resources

Intermediate Ability to effectively present information and respond to questions from families, members, and providers

Intermediate Ability to work within tight timeframes and meet strict deadlines

Intermediate Demonstrated written communication skills

Intermediate Ability to lead/manage others

Intermediate Ability to effectively present information and respond to questions from peers and management

Intermediate Ability to lead/manage others in a matrixed environment

Intermediate Knowledge of healthcare delivery

Intermediate Knowledge of community, state and federal laws and resources

Intermediate Other Demonstrate effective critical thinking and decision making skills Licenses and Certifications:A license in one of the following is required:

Technical Skills:

Required Intermediate Microsoft Word

Required Intermediate Microsoft Excel

Required Intermediate Microsoft PowerPoint

Required Intermediate Microsoft Outlook

Required Intermediate Healthcare Management Systems (Generic) Languages:

','US-FL-Tampa','8735 Henderson Rd','Ren 2','Tampa','33634','','','No','No','Mgr, Prior Authorization

Company info

Wellcare
Website : http://www.wellcare.com

Company Profile
WellCare Health Plans, Inc. focuses exclusively on providing government-sponsored managed care services, primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, to families, children, seniors and individuals with complex medical needs. The company served approximately 3.8 million members nationwide as of Sept. 30, 2015. For more information about WellCare, please review our website and view the company’s videos. WellCare has developed a full complement of expertise in three major areas of government-sponsored health care…. Medicaid, Medicare Advantage and Medicare Prescription Drug Plans. Leveraging our expertise for our members' benefit is a key part of the value we bring to our members. WellCare focuses on those members who are dually eligible for both Medicaid and Medicare. This is an area of specialization that many other health plans simply do not have. We are committed to continually improving the quality of care and service that we provide to our members. We help our members access the right care at the right time in the appropriate setting. For some members, this includes the use of coordinated care teams and community partnerships. And we’re focused on government customers and use a disciplined approach to ensure a competitive cost structure.

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