Blue Cross Blue Shield of Arizona · 4 weeks ago
Supervsior- Prior Authorization- Hybrid
AZ Blue Phoenix, AZ 85021
Full-time
Hybrid
Mid, Senior Level
3+ years expBlue Cross Blue Shield of Arizona is dedicated to inspiring health and providing a variety of health insurance products and services. The RN Prior Authorization Supervisor oversees the daily operations of the prior authorization team, ensuring that clinical standards and regulatory requirements are met while providing coaching and support to staff.
Financial ServicesHealth CareHealth InsuranceInsurance
Responsibilities
Ensures completion, accuracy and timeliness of medical, dental, Pharm D, and behavioral health authorization reviews to meet contractual requirements and ensures all reviews are conducted using InterQual or BCBSAZ Health Choice Clinical Policies
Ensures completion, accuracy, timeliness of NOA letters; member and provider notification
Supervises the prior authorization team, which consists of RNs and LPNs, who review and process prior authorization requests for services and items for the Dual Eligible Special Needs Plan (D-SNP),, Arizona Health Care Cost Containment System (AHCCCS), and possibly ACA commercial members
Monitors clinical teams’ performance and productivity and provide regular reports and feedback to the management
Ensures clinical team adheres to the clinical guidelines, criteria, and protocols, and follows the best practices and standards of care
Ensures clinical team complies with Centers for Medicare and Medicaid (CMS), National Committee for Quality Assurance (NCQA), Arizona Health Care Cost Containment System (AHCCCS), and Utilization Review Accreditation Commission (URAC), and plan-specific regulations and policies, and maintains effective documentation and records accordingly
Coordinates with requesting and servicing practitioners, members, and other internal departments to facilitate the prior authorization process and resolve any issues or concerns
Manages escalated cases, complex situations and provide clinical guidance and support to the clinical staff
Identifies and implement opportunities for improvement and innovation in the prior authorization process and workflow
Develops orientation onboarding and conduct training for new and existing staff and evaluate their competency and skills
Participates in quality improvement initiatives, audits, and compliance reviews
Performs other duties as assigned
Qualification
Required
3 years of direct clinical experience
3 years of experience in utilization review
3 years of in same or similar role, experience managing clinical direct reports
High-School Diploma or GED in general field of study
Active, current, and unrestricted license to practice in the State of Arizona as a Registered Nurse (RN)
Knowledge of InterQual Criteria Set
Computer documentation skills to include MS applications, Word, Adobe, Excel and Outlook
Communication skills: oral and written
Knowledge of and skill with clinical review and medical necessity determinations
3-5 years Supervisor experience in Prior Authorization/Utilization Review
Preferred
5 years of managed care/health plan experience
5 years of Medicaid and Medicare experience
Bachelor of Science in Nursing or Healthcare management field of study
Company
Blue Cross Blue Shield of Arizona
Blue Cross Blue Shield of Arizona is a non-profit company that offers health insurance and financial services.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Pam Kehaly
President and Chief Executive Officer
Recent News
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2025-11-22
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