Manager, Prior Authorizations

🔥 2 hours ago

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Kestra Medical Technologies, Inc.

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2014

🏥 Healthcare

🔧 Hardware

☁️ SaaS

Healthcare • Hardware • SaaS

Kestra Medical Technologies, Inc. is a medical technology company that develops the ASSURE wearable cardioverter defibrillator (WCD) and an integrated remote patient management platform. The ASSURE System combines a wearable device with autonomous sensing, arrhythmia detection, and effective defibrillation therapy, plus the Kestra CareStation remote data platform and a patient mobile application to support monitoring, compliance, and telehealth-enabled care for patients at elevated risk of sudden cardiac arrest (SCA). Kestra emphasizes digital healthcare, smart wearables, mobile connectivity, and lifesaving therapeutic interventions, and sponsors clinical evaluation such as the ACE-PAS study to demonstrate real-world performance and safety.

📋 Description

• Manage all aspects of the prior authorization department including timely, accurate prior authorization submission, renewals/extensions, follow-up, and appeals, including requests for single case agreements or gap exceptions • Analyze clinical review and prior authorization outcomes from all sources, including carrier denial exception reporting, first pass approval rate, appeal effectiveness, and clinical relevance rate • Work across departments to manage the entire process from receipt of patient’s clinical records, prior authorization submission, to final determination • Liaise with internal departments to promote ongoing communication, and collaboration on cross functional projects related to prior authorization optimization • Ensure that all metrics are achieved and develop actionable plans that will quickly and efficiently resolve deficits should those occur • Provide department orientation and ongoing training for all in/direct reports • Actively engage in optimization opportunities to drive automation, workflow improvement, and efficiency gains • Partner with internal and external customers to drive approval outcomes, minimizing revenue leakage • Hire and manage all staff members - drive a culture of respect, engagement, accountability, and results • Adhere to Pledge of Confidentiality

🎯 Requirements

• Bachelor’s degree • 3-5 years of leadership in the healthcare revenue cycle management function, with focus on prior authorization management • Strong understanding of clinical review and prior authorization management • Proven record of achieving aggressive metrics and outcomes

🏖️ Benefits

• Medical • Dental • 401K with Match • Pay equity initiatives