Director, Health Services (Pre-Authorization)
It’s a great time to put the strength of
Coventry Health Care, Inc. is a $12 billion growth oriented national managed health care company with 14,000 employees in 48 states. We are dedicated to serving the health care needs of our community and maintaining an organization with energetic, growth-minded, and loyal employees who are continually challenged to make a difference. The · Develop and direct the implementation of and adherence to health plan and department policies and procedures, goals and objectives as related to pre-authorization activities, · Oversee department compliance with NCQA utilization management standards, · Ensure proper staffing levels and competencies are appropriate to ensure that quality and timely service is provided to our members. This will include responsibility for future development of consolidated staffing models for pre and post service reviews with a focus on efficient and streamlined workflows, · Maintain a working knowledge and communication of legislature, impending insurance law changes that may potentially affect utilization trends, practices, and standards at the plan or corporate level, · Ensure staff receive appropriate and timely training regarding online medical management tools, · Coordinate and participate in Authorization related provider orientation, development, and maintenance activities, and · Prepare and monitor departmental budget. · Frequent travel required between APPLY TODAY if you: ·
We have an immediate opening for a professional and experienced Director of Health Services (Pre-Authorization) to oversee and guide our skilled staff as they administer and process all utilization management functions relating to preauthorization of outpatient testing/surgery, and inpatient admissions for our 500,000