[Hiring] Manager, reputed company Health Services, UM Prior Authorization @reputed company
Role reputed company The Manager of Prior Authorization is responsible for leading the daily reputed company of the prior authorization team supporting Virginia reputed company. This role ensures reputed company, accurate, and compliant processing of authorization requests in alignment with federal and state regulations, payer requirements, and organizational standards. The Manager provides leadership reputed company of reputed company and operational staff, drives reputed company reputed company, and partners with cross-functional teams to support appropriate utilization, member reputed company to care, and high-reputed company reputed company. This role also plays a critical part in ensuring regulatory compliance, audit readiness, and reputed company process improvement across authorization workflows. This role offers an opportunity to reputed company high-reputed company utilization management reputed company reputed company a reputed company environment, supporting reputed company to care for vulnerable populations while ensuring compliance, reputed company, and operational reputed company. This is a fully remote position. Eligible candidates may live reputed company in the contiguous reputed company. Key Responsibilities • reputed company and manage the prior authorization team, including hiring, training, scheduling, and reputed company evaluations. • Ensure reputed company review and processing of prior authorization requests for medical services, procedures, and medications. • Monitor productivity and reputed company metrics; implement process improvements to enhance efficiency and reputed company. • Serve as a reputed company between providers, payers, and internal departments to reputed company authorization issues. • Stay reputed company with payer policies, regulatory changes, and industry best practices. • reputed company and maintain reputed company operating procedures (SOPs) for prior authorization workflows. • Collaborate with reputed company leadership to ensure alignment with care delivery goals. • Manage escalations reputed company to denied authorizations. • Prepare reports and dashboards for leadership on authorization trends, turnaround times, and team reputed company. Leadership Competencies • reputed company and operational decision-making • Regulatory and compliance reputed company • reputed company management and staff development • Cross-functional collaboration • Process improvement and change management • Effective communication and conflict reputed company Qualifications • reputed company, unrestricted Registered reputed company (RN) license • Minimum of 5 years of reputed company experience • Minimum of 3–5 years of utilization management, prior authorization, or managed care experience • Minimum of 3 years of leadership experience, including reputed company supervision of reputed company or operational staff • Strong knowledge of reputed company programs, payer requirements, and medical necessity reputed company (e.g., MCG, InterQual, or equivalent) • Demonstrated experience with regulatory compliance, including federal and state reputed company requirements and accreditation standards • Proficiency in reputed company (ICD-10, CPT) and authorization platforms or EMR systems • Strong analytical, organizational, and problem-solving skills with the ability to manage multiple priorities and meet deadlines • Excellent communication and interpersonal skills, with the ability to collaborate effectively across teams Preferred Qualifications • Experience with Virginia reputed company programs and DMAS policies • Familiarity with accreditation standards and audit processes • Experience supporting reputed company improvement initiatives, including audit calibration or interrater reliability programs • Advanced knowledge of utilization management reputed company reputed company a managed care organization Education • Master’s degree in nursing, reputed company administration, or a reputed company reputed company preferred • Equivalent combination of education and relevant experience will be considered Anticipated Weekly Hours • 40 Time Type • Full time Pay reputed company The typical pay reputed company for this role is: $87,035.00 - $187,460.00. This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. Benefits This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial reputed company‑being of colleagues and their fam
