Supervisor Hospital Authorization

Nemours Foundation Wilmington, DE
As one of the nation's leading pediatric health care systems, Nemours is committed to providing all children with their best chance to grow up healthy. We offer integrated, family-centered care to more than 300,000 children each year in our pediatric hospitals, specialty clinics and primary care practices in Delaware, Florida, Maryland, New Jersey and Pennsylvania. Nemours strives to ensure a healthier tomorrow for all children – even those who may never enter our doors – through our world-changing research, education and advocacy efforts. At Nemours, our Associates help us deliver on the promise we make to every family we have the privilege of serving: to treat their child as if they were our own.

The Hospital Preauthorization Department Supervisor has extensive authorization knowledge. He or she is able to handle complex authorization issues for any surgical and non surgical elective and non elective admissions including solid organ and bone marrow transplants. The authorization responsibility extends to several outpatient departments. The Supervisor will be to provide direct support to the department's elective and urgent Authorization Specialists and Preadmission Specialist. The Supervisor will monitor Hospital and Physician authorization workqueues to ensure cases are worked timely and other required information is satisfied. The Supervisor will deploy staff to work appropriate inpatient and outpatient specialties as needed to even the workload and for proper coverage. Monthly documentation audits and 10 day out goal calculation are the responsibility of the department Supervisor. Audit results will be shared with the department each month so the goal numbers can be entered in Performance Management. The Supervisor will monitor daily conversions and report monthly the conversion turnaround time with Manager to identify areas of improvement. The Supervisor will work closely with Utilization Review and Physician Authorization departments. He or she will work with the Transplant Coordinator on transplant patients to provide coverage as needed. The Supervisor will have the ability to cover all authorization types, participate in organizational committees/task forces, attend payor meetings and demonstrate effective utilization of EPIC applications as indicated by performance measures. This position will also assist with new associate training. The Hospital Authorization Department Supervisor, under the direction of the Manager, provides continuous quality improvement by monitoring/adjusting workflows, identifying opportunities, suggesting improvements and initiating implementation. This Supervisor position serves as the role model for others and a system/process expert

Requirements

* Lead or Supervisor experience required.

* Advanced urgent and elective surgical and non surgical inpatient (including transplant) and outpatient hospital authorization experience required.

* Advanced knowledge of physician authorizations

* Microsoft outlook, word and excel

* Advanced knowledge of Midas, Navinet, various insurance companies' online eligibility authorization required. ICD/CPT/HCPCS knowledge required.

Preferred

* Advanced knowledge of Epic's ADT, Workqueues, Referral, Prelude and Resolute Hospital billing applications

Our dedication to professionals who are dedicated to children frequently earns Nemours a spot on the list of top workplaces in the communities we serve. Our Associates enjoy comprehensive benefits, including our unique "Bridge to a Healthy Future" pediatric health plan, an integrated wellness program, opportunities for professional growth, and much more. As an equal opportunity employer, Nemours focuses on the best-qualified applicants for our openings.

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