Prior Auth Program Specialist

##### Description Responsible for maintaining and educating staff and key stakeholders on the q.Auth Referral, Test and Production sites, including programming changes, auto approvals, queue management and employee access and processing rights. ##### Professional Duties Develop and maintain training materials for UM Referrals Management System regarding data entry and processing of referrals. Oversee and administer employee access and workflow configuration within the UM Referrals Management System, ensuring appropriate system access, processing level assignments, and queue management to maintain efficient operations and service delivery. Educate and serve as a resource to employees and key stakeholders on processing requirements as required by Health Plan and CMS regulations. Facilitate and coordinate assigning and monitoring senior referral coordinators during their training of staff, to include but not limited to; review senior coordinators training of new employees, checking the completed duties associated with the new employee training orientation checklist. Establish, streamline, and implement relevant job aids and assist with reviewing new/current policies to ensure UM referral processing accuracy. Collaborate with key stakeholders and HPN to evaluate new training needs. Assist with CMS and Health Plan Corrective Action Planning (CAP) completion, submission and all follow up and action items. Visit IPA offices to assist with ad hoc training needs. Assist leadership with any process analysis and recommend/assist with any process improvement projects needed. Oversees and manage all ongoing program changes to reflect new and terminated employees/stakeholders/providers are added/removed from UM Referrals Management System. Inform leadership of any insufficiencies and challenges encountered while auditing training by senior coordinators and new employees within a two week window. Assists Director of Referrals with assigning and auditing training of new Referral/UM employees, other DOHC departments, contracted third party staff and other key stakeholders to the q.Auth Referrals Management System. Perform other duties as assigned. Do your share. Do what you say you will do and take action, follow through. Be willing to pitch in and help Assume a neutral position and suspend judgment of others Be accountable for your work Speak positively about your work, co-workers and Desert Oasis Healthcare and Family Hospice Care Avoid gossip and negativity ##### Qualifications Bachelor's degree in Healthcare Administration, or 6 additional years of utilization review experience in lieu of the degree. 4 years experience in Utilization review required. Knowledge of medical terminology. Knowledge of diagnosis and procedure coding practices. Knowledge of managed care environment. Knowledge of Federal, State, and Health Plan laws and regulations relevant to departmental operations and functions. Ability to utilize personal judgement and critical thinking to problem solve. Ability to work collaborative and be a contributing member of a team. Ability to work independently with minimal supervision. Communication: Ability to effectively communicate with individuals within all levels of the organization, patients, patient family members, providers, vendors and others. Excellent customer service and telephone etiquette skills. Microsoft and Computer Skills: Ability to utilize Microsoft Office applications (Word, Excel, Outlook, Power Point) and other computer software/applications. Time Management: Detail oriented and organizational skills. Ability to manage time effectively and prioritize tasks to meet established deadlines. Current California driver's license and proof of auto insurance. At the discretion of DOHC/FHC management, this position ha the potential to be a full or hybrid telecommuting position. ##### Physical Demands Type Description Sitting Approximately 60% of day. Standing Approximately > 20% of day. Walking Approximately > 20% of day. Lifting 0 - 20 lbs. (equipment, supplies) approximately >10% of day. Bending Approximately >10% of day. Kneeling <10%. Hearing/Visual Acuity Adequate for use with computers, telephone and/or Blackberry. Approximately 100% of day. Computer Highly technical work environment. Must be able to work minimum of 6 hours a day using keyboard, mouse and monitor. Reaching Above head 75 degrees approximately 10% of day.