Team Lead, Authorization Management Clinical Reviewer
WellSky
full-time
Posted on:
Location Type: Remote
Location: New York • United States
Visit company websiteExplore more
Job Level
About the role
- Oversee daily operations of clinical operation support staff and ensure tasks are completed efficiently and accurately
- Serve as the primary point of contact for team communications by promoting collaboration and resolving minor operational challenges
- Assist in the development and execution of work plans, assign tasks, and monitor completion to meet team goals
- Provide direct support and guidance to team members, including on-the-job training and resource allocation
- Ensure compliance with organizational policies and maintain accurate documentation of team activities
- Monitor team performance metrics to identify areas for improvement and ensure quality service delivery
- Perform other job duties as assigned
Requirements
- Bachelor's Degree or equivalent work experience
- 0-1 years of relevant management work experience
- At least 4-6 years relevant work experience
- Active RN License
- 2 years clinical acute nursing experience
- 1-2 years of hospital-based utilization management experience
- Bachelor's Degree in Nursing (preferred)
- Denials and Appeals experience (preferred)
- Experience with managed care and CMS standards (preferred)
- Proficient in the use of window-based computer programs (preferred)
- Excellent verbal, written, and interpersonal communication skills (preferred)
- Critical thinking skills, creative problem solving, and proficient organization and planning skills (preferred)
- Experience with InterQual guidelines for acute-care and/or other clinical decision support tools, especially in utilization management and prior authorization processes (preferred)
- Experience with CarePort Care Management (preferred)
Benefits
- Excellent medical, dental, and vision benefits
- Mental health benefits through TelaDoc
- Prescription drug coverage
- Generous paid time off, plus 13 paid holidays
- Paid parental leave
- 100% vested 401(K) retirement plans
- Educational assistance up to $2500 per year
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
clinical acute nursing experiencehospital-based utilization management experiencedenials and appeals experienceInterQual guidelinesclinical decision support toolsprior authorization processes
Soft skills
team communicationcollaborationproblem solvingorganizationplanningcritical thinking
Certifications
Bachelor's DegreeActive RN License