Prior Authorization Review Coordinator

Prior Authorization Review Coordinator – Four Positions 

Do you have an interest in helping Oregonians in need by assisting healthcare providers? Do you have at least three years of experience providing information about services and programs; explaining rules, programs, and procedures; and/or providing assistance, explaining requirements, and gaining compliance?  We look forward to hearing from you!

Work Location: Salem/Marion or Portland/Multnomah; hybrid position

What you will do!

Each of the four Prior Authorization Review (PAR) Coordinator positions below are responsible for receiving prior authorization (PA) requests for services covered by the Oregon Health Plan (OHP) and initiating the steps required to complete the processing, review and determination of the PA requests. These positions utilize Oregon Administrative Rules, member information and benefit package information to interpret applicable rules, regulation, decisions, policies and procedures to ensure that complete and accurate PA information has been received from the requestor and assisting the requester with compliance of program requirements. These positions also support Medicaid service providers by operating a provider hotline during normal business hours, and by managing a variety of tasks related to prior authorization and unit functions. These positions will also be responsible to work with policy teams to offer feedback toward process improvement and compliance with due process policies. In addition, these positions will work with the OHP Medical Leadership team for both complex clinical decisions and policy and process improvement strategies. We are hiring two positions to support review of Behavior Rehabilitation Services and two positions to support review of Personal Care Attendant Services.

Behavior Rehabilitation Services (2 positions). BRS is a program that utilizes a residential care or proctor care model to provide services to people who are multi-system involved. The service is intended to offer services with psychological emotional and behavioral conditions and disorders. This position is also responsible for supporting the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program by identifying and approving clinically necessary services for members younger than 21 years of age. In addition, this position will work with the OHP Medical Leadership team for both complex clinical decisions and policy and process improvement strategies. This position will ensure prior authorization criteria is met for BRS services and that services are approved in accordance with applicable BRS rules and state plan authority. This position may also assume supportive roles for the PRTF benefit program as needed.

Personal Care Attendant Services (2 positions). PCA services seek to support activities of daily living and instrumental activities of daily living for individuals diagnosed with chronic mental illness. PCA services are intended to improve or maintain an individual’s condition and mitigate further regression, minimizing the need of more acute services. PCA services need to be determined as medically necessary and medically appropriate to meet an individual’s personal care needs in their own or family home. This position is also responsible for supporting the in-home personal care program and agency with choice program. This position may also assume supportive roles to ensure prior authorization criteria is met for behavioral rehabilitation services (BRS) and psychiatric residential treatment services (PRTS) approved in accordance with applicable BRS rules, PRTS rules, and state plan authority.

OHA values service excellence, leadership, integrity, health equity and partnership and has a strategic goal to end all health inequities by 2030.

What's in it for you?

• We offer exceptional medical, vision and dental benefits packages for you and your qualified family members, with very low monthly out-of-pocket costs.
• Paid Leave Days:
  • 11 paid holidays each year
  • 3 additional paid "Personal Business Days" each year
  • 8 hours of paid sick leave accumulated every month
  • Progressive vacation leave accrual with increases every 5 years
• Pension and retirement programs
• Optional benefits include short-term disability, long-term disability, deferred compensation savings program, and flexible spending accounts for health care and childcare expenses.

WHAT WE ARE LOOKING FOR:

Minimum Qualifications

Three years of experience performing public contact and/or customer service duties comparable to the work of a Public Service Representative.

At least two years of this experience must include dealing with the public in-person or by phone providing information about services and programs; explaining rules, programs, and procedures; and/or providing assistance, explaining requirements, and gaining compliance.

Desired Attributes

• Experience in creating and maintaining a work environment that is respectful and accepting of diversity among team members and the people we serve.
• Evidence of ongoing development of personal cultural awareness and humility, and knowledge of social determinants of health and their impacts on health outcomes.
• Experience supporting the implementation of policies, projects and programs at the community, state, and/or national level that advance health equity, address systemic health disparities, and elevate the voice of community and those with lived experience.
• Experience factoring in the perspectives of diverse populations most harmed by social injustice and inequities including communities of color, immigrant groups, the disability and neurodivergent communities, veterans, older adults, individuals identifying as LGBTQIA+ and other communities that have been traditionally marginalized.
• Knowledge of federal requirements, state rules and program requirements for the Oregon Medicaid Program.
• Experience within the context of healthcare claims processing.
• Ability to demonstrate advanced Microsoft Excel, Word, Outlook, and use of collaboration tools such as Microsoft Teams and SharePoint .
• Demonstrates skills in the following areas:
• Constructive and Collaborative Working Relationships
• Critical Decision-making and Problem-solving
• Customer Service and Person-centered Engagement
• Workload Planning and Prioritization
• Team Collaboration & Workload Collaboration
• Written and oral communication, including preparation of reports and presentations
  

How to apply:

Complete the online application at oregonjobs.org using job number REQ-151036

Deadline: 3/17/2024

https://oregon.wd5.myworkdayjobs.com/SOR_External_Career_Site/job/Salem--OHA--Summer-Street/Prior-Authorization-Review-Coordinator---four-positions--Public-Services-Representative-4-_REQ-151036-1