Director, Authorizations Operations

Overview

Develops, 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.

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 administration, 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

Pay Range

USD $122,300.00 - USD $164,000.00 /Yr.

About Us

VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We’re one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.

Responsibilities

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 administration, 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