Manager, Clinical Operations
New
R
Rosarium HealthHealthcare Technology
Remote (United States)Full-TimeManager
Salary95,000 - 110,000 USD per year
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Job Details
- Experience
- 4–8 years
- Required Skills
- Operations Management
Requirements
- 4–8 years of experience in homecare, health plan, clinical operations, or utilization management
- Knowledge and/or experience with Payer Prior Authorization process
- Strong clinical background, preferably in the home setting
- Experience in training clinicians and developing training materials
- Experience managing clinician performance
- Ability to identify areas for operational efficiencies
- Comfortable working across functional areas including Product and Engineering teams
- Preferred: Licensed Occupational Therapist (OT), Physical Therapist (PT), or Registered Nurse (RN)
- Preferred: Knowledge of Managed Medicaid, Medicare Advantage, D-SNP
Responsibilities
- Manage the Prior Authorization process with Payers
- Oversee the end to end process for prior authorization submission, timely approval and respond to denials and appeals
- Work with operations staff for timely completion of internal documentation and processes
- Identify process improvement opportunities to streamline process for approval and mitigate denials
- Provide onboarding and initial training for all new network clinicians
- Provide ongoing support to clinicians and develop educational programs
- Oversee clinician performance including documentation on assessments and compliance
- Collaborate with product and tech to enhance data collection and reporting from assessments
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