Norton Healthcare
Director, Authorization Management
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Norton Healthcare , Louisville, KY.
Responsibilities The Director of Authorization Management leads and manages a team composed primarily of care managers (including system care managers), utilization review nurses (RN, LPN), and insurance verification representatives. This team develops processes for prospective, concurrent, and retrospective utilization review, provides timely notification of admission to third‑party payors and managed care companies, and works closely with hospital‑based care managers to provide clinically accurate, timely and meaningful inpatient/observation reviews to payors for admission approval. The Director collaborates with external staff (payors) and internal NHC health‑care team members (Patient Financial Services, Registration, Health Information Management, Care Management). As a key leader in Norton Healthcare’s Improvement Network, the Director coaches and facilitates performance‑improvement initiatives, tracks, trends, and reports key financials (lost revenue due to denials), and provides guidance on preventing and appealing denials and on medical‑necessity criteria such as InterQual and/or Milliman Care Guidelines.
Key Accountabilities
Provides annual performance evaluations for direct reports and offers feedback to other system leaders as requested; evaluates engagement results and works with teams to establish action plans.
Mentors and coaches the team to ensure they have the tools and training to meet goals and deliver quality patient care.
Identifies and coordinates improvement opportunities, leads formal groups to reduce insurance denials/loss of revenue, continuously streamlines the authorization process, and collaborates with staff/leaders in other departments.
Manages departmental financial resources to meet and exceed performance metrics and budget expectations while demonstrating critical thinking, problem‑solving, and prioritization.
Ensures proper hospital/payor authorization requirements are met, maintains organized databases of payor requirements, reviews, contacts, decisions and appeals, and stays knowledgeable of managed care contracts, government payment methodologies and coverage guidelines.
Qualifications Required
Three years of management experience in a care management/care coordination setting.
Bachelor’s degree.
Registered Nurse (RN).
Desired
Master’s degree.
Certified Case Manager or Certified Professional in Denial & Appeal Management.
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at
Norton Healthcare , Louisville, KY.
Responsibilities The Director of Authorization Management leads and manages a team composed primarily of care managers (including system care managers), utilization review nurses (RN, LPN), and insurance verification representatives. This team develops processes for prospective, concurrent, and retrospective utilization review, provides timely notification of admission to third‑party payors and managed care companies, and works closely with hospital‑based care managers to provide clinically accurate, timely and meaningful inpatient/observation reviews to payors for admission approval. The Director collaborates with external staff (payors) and internal NHC health‑care team members (Patient Financial Services, Registration, Health Information Management, Care Management). As a key leader in Norton Healthcare’s Improvement Network, the Director coaches and facilitates performance‑improvement initiatives, tracks, trends, and reports key financials (lost revenue due to denials), and provides guidance on preventing and appealing denials and on medical‑necessity criteria such as InterQual and/or Milliman Care Guidelines.
Key Accountabilities
Provides annual performance evaluations for direct reports and offers feedback to other system leaders as requested; evaluates engagement results and works with teams to establish action plans.
Mentors and coaches the team to ensure they have the tools and training to meet goals and deliver quality patient care.
Identifies and coordinates improvement opportunities, leads formal groups to reduce insurance denials/loss of revenue, continuously streamlines the authorization process, and collaborates with staff/leaders in other departments.
Manages departmental financial resources to meet and exceed performance metrics and budget expectations while demonstrating critical thinking, problem‑solving, and prioritization.
Ensures proper hospital/payor authorization requirements are met, maintains organized databases of payor requirements, reviews, contacts, decisions and appeals, and stays knowledgeable of managed care contracts, government payment methodologies and coverage guidelines.
Qualifications Required
Three years of management experience in a care management/care coordination setting.
Bachelor’s degree.
Registered Nurse (RN).
Desired
Master’s degree.
Certified Case Manager or Certified Professional in Denial & Appeal Management.
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