Manager, Prior Authorization
K
knownwellHealthcare
RemoteFull-TimeManager
Salary$110K - $125K; $110K – $125K
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Job Details
- Experience
- 5-7 years of prior authorization experience, including 3+ years in a leadership role
- Required Skills
- Operations ManagementEHR
Requirements
- 5-7 years of prior authorization experience.
- 3+ years in a leadership role managing a Prior Authorization or similar insurance-facing operations team.
- Deep working knowledge of the Prior Authorization lifecycle and payer requirements.
- Experience with CoverMyMeds.
- Experience with an EHR (Athena strongly preferred).
- Experience managing distributed or blended teams (in-house + BPO/outsourced).
- Proven ability in vendor management.
- Track record of building and measuring structured processes.
- Strong cross-functional communication skills.
- Ability to work under volume pressure with a focus on root-cause problem solving.
- Familiarity with GLP-1s or obesity management medications is a plus.
Responsibilities
- Manage and coach a team of Prior Authorization specialists, including performance management, scheduling, and staffing continuity.
- Own the outsourced staffing vendor relationship, including capacity planning and quality oversight.
- Manage Prior Authorization turnaround time, coverage rate, and backlog metrics, providing visibility to leadership.
- Maintain structured status tracking and work-list management in Athena and CoverMyMeds.
- Develop and evolve competency frameworks, training materials, and SOPs for handling complex payer requirements.
- Partner with clinicians to resolve complex cases and address escalation issues.
- Identify and resolve process or tooling breakdowns to prevent patient-facing failures.
- Lead hiring, onboarding, and training of new team members.
- Report performance and risk metrics to Central Operations leadership.
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