Supervsior- Prior Authorization- Hybrid

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month
• Onsite: daily onsite requirement based on the essential functions of the job
• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one‑on‑ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

This position is hybrid within the state of AZ only. This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.

The RN Prior Authorization Supervisor is responsible for overseeing the daily operations of the prior authorization team for the Medicaid Segment which includes Medicaid, Medicare Advantage / Dual Eligible Special Needs Plan (D‑SNP), and may include Affordable Care Act (ACA) members. The supervisor ensures the clinical team meets the quality and productivity standards, follows policies and procedures, and complies with all BCBSAZ Health Choice regulatory requirements.

The supervisor maintains and/or creates desktop procedures for effective workflows and participates in policy oversight with leader. The supervisor provides coaching, feedback, and training to the clinical staff, and manages escalation issues and complex cases. The supervisor will provide support to the clinical staff accountable for the Notice of Action (NOA) process. The supervisor will provide support to the non‑clinical paraprofessionals which include Prior Authorization (PA) and may include NOA technicians, assisting in overall department initiative and training of both clinical and non‑clinical staff.

REQUIRED QUALIFICATIONS

Required Work Experience

• 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

Required Education

• High‑School Diploma or GED in general field of study

Required Licenses

• Active, current, and unrestricted license to practice in the State of Arizona as a Registered Nurse (RN)

Required Certifications

• N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience

• 5 years of managed care/health plan experience
• 5 years of Medicaid and Medicare experience

Preferred Education

• Bachelor of Science in Nursing or Healthcare management field of study

Preferred Licenses

• N/A

Preferred Certifications

• N/A

• 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 Inter Qual 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…