Prior Authorization Supervisor

Location: 600 Holiday Plaza Dr, Matteson, IL 60443

About the Role

The Prior Authorization Manager supervises, consults, and guides prior authorization staff responsible for responding to all prior authorization requests. The manager ensures all requests are complete—including inpatient, outpatient, procedures, and therapies—in accordance with best practices, Cook County Health (CCH) Policies and Procedures, and Health Plan standards. The role ensures all documentation is obtained to support level of care, medical appropriateness, and authorization.

Responsibilities

• Oversees the day-to-day operations and supervision of the Prior Authorization team, including drug, imaging, surgery, radiation oncology, and other areas, providing expertise and guidance across Cook County Health.
• Routinely reviews and communicates payer authorization guidelines and policy changes to the Prior Authorization staff.
• Communicates with physician/clinical staff on escalated reimbursement issues and/or off-label drug usage utilizing guidelines set forth by the patient’s insurance.
• Assists with medical necessity documentation to expedite approvals and ensures appropriate follow-up is performed.
• Oversees the orientation and training of new employees and provides on-site training as needed.
• Provides backup coverage as needed to the Prior Authorization team.
• Performs monthly audits for each employee to ensure data quality, insurance verification, and overall account documentation compliance.
• Recommends action to outside stakeholders, as necessary, to resolve problems proactively.
• Remains current with industry trends, changes to insurance policies, and other developments that may impact the authorization process.
• Engages in process and quality improvement initiatives.
• Complies with patient confidentiality policies for the retention, handling, distributing, or disposing of patient health information.
• Performs other duties as assigned.

Administrative Responsibilities

• Collective Bargaining: Reviews applicable Collective Bargaining Agreements and consults with Labor Relations to generate management proposals. Participates in collective bargaining negotiations, caucus discussions, and working meetings.
• Discipline: Documents, recommends, and effectuates discipline at all levels. Works closely with labor relations and/or labor counsel to enforce applicable Collective Bargaining Agreements. Initiates, authorizes, and completes disciplinary action pursuant to CCH system rules, policies, procedures, and provisions of applicable collective bargaining agreements.
• Supervision: Directs and effectuates CCH management policies and practices. Accesses and navigates CCH records systems to obtain and review information necessary to execute provisions of applicable collective bargaining agreements.
• Management: Contributes to the management of CCH staff and systemic development and success. Discusses and develops CCH system policies and procedures. Uses independent judgment to identify operational staffing issues and needs, performing functions such as hiring, transferring, suspending, laying off, recalling, promoting, discharging, assigning, directing, or disciplining employees pursuant to applicable Collective Bargaining Agreements. Works with Labor Relations to discern past practice when necessary.

Requirements

• High School diploma or GED equivalent with six (6) years of prior authorization experience or a Bachelor’s degree with three (3) years of prior authorization experience. Official college transcripts must be provided at the time of the interview.
• A minimum of four (4) years of experience processing insurance requests to obtain prior authorization.
• Experience and familiarity with using insurance portals (e.g., Anthem, Availity, Evicor, CoverMyMeds, Magellan).

Preferred Qualifications

• Knowledge and experience with payer processes to submit appropriate clinical documentation.
• Experience using medical terminology.

Skills

• Excellent verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups.
• Knowledge and proficiency with Microsoft applications and internet-based programs.
• Strong interpersonal skills with the ability to establish strong working relationships.
• Strong time management skills to prioritize assignments and meet designated deadlines.
• Ability to work in a team-based environment to accomplish goals and objectives.
• Ability to demonstrate respect and sensitivity for cultural diversity in the CCH workforce and patient population.

Benefits

• Medical, Dental, and Vision Coverage
• Basic Term Life Insurance
• Pension Plan and Deferred Compensation Program
• Employee Assistance Program
• Paid Holidays, Vacation, and Sick Time
• 100% Tuition Reimbursement for nursing-related programs
• Eligibility for the Public Service Loan Forgiveness Program (PSLF)

Pay

Salary range: $109,309–$123,683 yearly. Salary is commensurate with years of experience indicated at the time of application submission. Experience not disclosed or documented at the time of application will not be considered for initial step placement.

Schedule

Shift: 8:00 AM – 4:00 PM

Physical and Environmental Demands

This position functions within a healthcare environment. The incumbent is responsible for adhering to all hospital and department-specific safety requirements, including but not limited to:

• Complying with Personal Protective Equipment requirements.
• Following handwashing and sanitizing practices.
• Adhering to department-specific engineering and work practice controls and any other work area safety precautions as specified by hospital-wide policy and departmental procedures.