Strategic Prior Authorization Lead

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

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.