Are you an internal caregiver, student, or contingent worker/agency worker at UMass Memorial Health? CLICK HERE to apply through your Workday account.

Exemption Status:

Non-Exempt

Schedule Details:

Scheduled Hours:

Shift:

1 - Day Shift, 8 Hours (United States of America)

Hours:

40

Cost Center:

10020 - 3851 Pharmacy Business Office

Union:

SHARE (State Healthcare and Research Employees)

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 16,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

Major Responsibilities:

Completes prior authorization process for specialty medications.Works with multiple insurance carriers/vendors and keeps current with any and all changes as they relate to prior authorizations.Communicates / interacts with specific divisions within the UMass system regarding approved or denied prior authorizations. Coordinates with Financial Clearance, the Central Billing Office and other Departments in order to resolve prior authorization issues.Coordinates process for authorization using defined best practices.Coordinates the prior authorization workflow for the prior authorization coordinator(s), ensuring appropriate management of non-priority and priority/urgent needs and timely communication back to the requesting division.Manages the “Department Schedule Report(s)” ensuring appropriate Prior Authorizations are in place.Utilizing appropriate databases, tracking mechanisms, and tools, manages all prior authorization renewals to assure no lapse in medication treatment coverage. Performs weekly prior authorization audit to ensure accurate billing and resolves issues that arise.Produces correspondence, reports, memos, etc. as required.Sets up and maintains confidential, sensitive files and records for multiple functions, academic materials, medical records, etc. ensuring efficient retrieval of information. Coordinates retrieval of medical records.Ensures adequate inventory of office supplies and basic maintenance of office equipment.Participates in performance improvement initiatives and demonstrates the use of quality improvement in daily operations.Ensures compliance with health and satiety requirements and with regulatory agencies such as DPH, etc.

Standard Lead Level Responsibilities:

Distributes and monitors the flow of work for an assigned group of employees.  Provides training and technical assistance to employees within the assigned work area.  Assists supervisor in assuring that assigned employees are provided with appropriate resources, materials, and methods.  Provides recommendations to manager or supervisor for the most efficient utilization of assigned personnel.  Relays work instruction from the supervisor.Complies with established departmental policies, procedures, and objectives.Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.Attends variety of meetings, conferences, and seminars as required or directed.Demonstrates use of quality improvement in daily operations.Complies with all health and safety regulations and requirements.Maintains, regular, reliable, and predictable attendance.Performs other similar and related duties as required or directed.

Position Qualifications:

License/Certification/Education:
Required:

High School diploma.

Experience/Skill:
Required:

Minimum of 2 years of prior authorization experience.Recognized ability to coordinate daily operations of busy office environment and delegate duties as assigned.Ability to work in a team environment.Excellent customer service skills.

Preferred:

5 years of prior authorization experience.Prior authorization experience in an infusion setting. Must be proficient in the following software applications: Microsoft Office and Epic and proficient internet skills.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We’re striving to make respect a part of everything we do at UMass Memorial Health – for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.