Prior Authorization Supervisor

Cook County Health; Illinois; On-site; USD 109,000 - 124,000; Full time

Benefits offered by this job

Medical, Dental, and Vision Coverage

Pension Plan and Deferred Compensation

100% Tuition Reimbursement for nursing

Job summary

Cook County Health in Illinois seeks a Prior Authorization Manager to supervise staff handling all prior authorization requests across inpatient, outpatient, procedures and therapies. The role ensures documentation supports level of care and medical necessity in line with policies and health plan standards.

The manager guides staff, reviews payer guidelines, and coordinates with physicians to resolve escalations while maintaining compliant processes and data integrity.

Qualifications

• High School diploma or GED with 6 years of prior authorization experience or a Bachelor's with 3 years of prior authorization experience.
• Minimum of 4 years of experience processing insurance requests to obtain prior authorization.
• Experience with insurance portals (Anthem, Availity, Evicor, CoverMyMeds, Magellan).

Responsibilities

• Oversees day-to-day operations of the Prior Authorization team across drug, imaging, surgery, radiation oncology, etc.
• Routinely reviews payer authorization guidelines and policy changes for staff.
• Communicates with physician/clinical staff on escalated reimbursement issues.
• Assists with medical necessity documentation to expedite approvals and follow-ups.
• Provides onboarding and on-site training for new employees.

Skills

Communication skills

Verbal and written communication

Interpersonal skills

Time management

Teamwork

Cultural sensitivity

Education

Bachelor's degree

Tools

Anthem

Availity

Evicor

CoverMyMeds

Magellan

Job description

LOCATION: 600 HOLIDAY PLAZA DR, MATTESON, IL 60443

DEPARTMENT: Revenue

SHIFT: 8:00AM - 4:00PM

PAY RANGE: $109,309-$123,683 YEARLY

Salary is commensurate with years of experience indicated at time of application submittal. Experience not disclosed or documented at the time of application will not be considered for initial step placement.

JOB SUMMARY

The Prior Authorization Manager supervises, consults, and guides prior authorization staff responsible for responding to all prior authorization requests. The Prior Authorization Manager ensures all requests are complete to include inpatient, outpatient, procedures, and therapies in accordance with best practices, Cook County Health (CCH) Policies and Procedures and Health Plan standards. The Prior Authorization Manager ensures all documentation is obtained to support level of care, medical appropriateness, and authorization.

GENERAL ADMINISTRATIVE RESPONSIBILITIES

Collective Bargaining

• Review applicable Collective Bargaining Agreements and consult with Labor Relations to generate management proposals
• Participate in collective bargaining negotiations, caucus discussions and working meetings

Discipline

• Document, recommend and effectuate discipline at all levels
• Work closely with labor relations and/or labor counsel to effectuate and enforce applicable Collective Bargaining Agreements
• Initiate, authorize and complete disciplinary action pursuant to CCH system rules, policies, procedures and provision of applicable collective bargaining agreements

Supervision

• Direct and effectuate CCH management policies and practices
• Access and proficiently navigate CCH records system to obtain and review information necessary to execute provisions of applicable collective bargaining agreements

Management

• Contribute to the management of CCH staff and CCH’ systemic development and success
• Discuss and develop CCH system policies and procedures
• Consistently use independent judgment to identify operational staffing issues and needs and perform the following functions as necessary; hire, transfer, suspend, layoff, recall, promote, discharge, assign, direct or discipline employees pursuant to applicable Collective Bargaining Agreements
• Work with Labor Relations to discern past practice when necessary

Typical Duties

• Oversees the day-to-day operations and supervision of the Prior Authorization team including drug, imaging, surgery, radiation oncology, etc., providing expertise and guidance across Cook County Health.
• Routinely reviews and communicates payer authorization guidelines, and policy changes to the Prior Authorization staff.
• Communicates with physician/clinical staff on escalated reimbursement issues and/or off label drug usage utilizing guidelines set forth by the patient’s insurance.
• Assists with medical necessity documentation to expedite approvals and ensure that appropriate follow‑up is performed.
• Oversees the orientation and training of new employees and provide on‑site training as needed.
• Provides backup coverage as needed to the Prior Authorization team.
• Performs monthly audits for each employee to ensure data quality, insurance verification, and overall account documentation compliance.
• Recommends action to outside stakeholders, as necessary, to resolve problems proactively.
• Remains current with industry trends, changes to insurance policies, and other developments that may impact the authorization process.
• Engages in process and quality improvement initiatives.
• Complies with patient confidentiality policies for the retention of patient information, handling, distributing, or disposing of patient health information.
• Reports to the Prior Authorization Manager.
• Performs other duties as assigned

Minimum Qualifications

• High School diploma or GED equivalent with six (6) years of prior authorization experience or Bachelors with three (3) of prior authorization experience (Must provide copy of official college transcripts at time of interview). Is Required
• A minimum of Four ((4) years of experience processing insurance request to obtain prior authorization. Is Required
• Experience and familiarity with using insurance portals, i.e., Anthem, Availty, Evicor, Covermymeds, Magellang. Is Required

Preferred Qualifications

• Knowledge and experience with payer processes to submit appropriate clinical documentation? is Preferred
• Experience using Medical Terminology? is Preferred

Knowledge, Skills, Abilities And Other Characteristics

• Excellent verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups
• Knowledge and proficiency with Microsoft applications and internet-based programs
• Strong interpersonal skills with the ability to establish strong working relationships
• Strong time management skills to prioritize assignments and meet the designated deadline
• Ability to work in a team‑based environment to accomplish goals and objectives
• Ability to demonstrate respect and sensitivity for cultural diversity in CCH work force and patient population

Benefits Package

• Medical, Dental, and Vision Coverage
• Basic Term Life Insurance
• Pension Plan and Deferred Compensation Program
• Employee Assistance Program
• Paid Holidays, Vacation, and Sick Time
• 100% Tuition Reimbursement for nursing‑related programs
• You may also qualify for the Public Service Loan Forgiveness Program (PSLF)

Physical and Environmental Demands

This position is functioning within a healthcare environment. The incumbent is responsible for adherence to all hospital and department specific safety requirements. This includes but is not limited to the following policies and procedures: complying with Personal Protective Equipment requirements, hand washing and sanitizing practices, complying with department specific engineering and work practice controls and any other work area safety precautions as specified by hospital wide policy and departmental procedures.

VETERAN PREFERENCE

When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service

To Take Advantage Of This Preference a Veteran Must

• Meet the minimum qualifications for the position .
• Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question, “Are you a Military Veteran?”
• Attach a copy of their DD 214, DD 215 or NGB 22 (Notice of Separation at time of application filing. Please note: If you have multiple DD214s, 215s, or NGB 22S, Please submit the one with the latest date. Coast Guard must submit a certified copy of the military separation from either the Department of Transportation (Before 9/11) or the Department of Homeland Security (After 9/11). Discharge papers must list an Honorable Discharge Status. Discharge papers not listing an Honorable Discharge Status are not acceptable.

A copy of a valid State ID Card or Driver’s License which identifies the holder of the ID as a Veteran, may also be attached to the application at time of filing.

If items are not attached, you will not be eligible for Veteran Preference

VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARD OR DRIVER’S LICENSE AT TIME OF INTERVIEW.

MUST MEET ALL REQUIRED QUALIFICATIONS AT TIME OF APPLICATION FILING.

Degrees awarded outside of the United States with the exception of those awarded in one of the United States' territories and Canada must be credentialed by an approved U.S. credential evaluation service belonging to the National Association of Credential Evaluation Services (NACES) or the Association of International Credential Evaluators (AICE). Original credentialing documents must be presented at time of interview.

COOK COUNTY GOVERNMENT HEALTH AND HOSPITALS SYSTEM IS AN EQUAL OPPORTUNITY EMPLOYER.

Job Posting

Aug 21, 2026, 1:17:51 PM

Collective Bargaining Unit

None

Organization

Health and Hospital Systems