Manager, Prior Authorization

🕒 September 22

🇺🇸 United States – Remote

💵 $110k - $125k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 3%

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📋 Description

• Manage and coach Prior Authorization specialists, including performance management, scheduling, coverage planning, and staffing continuity • Own the outsourced staffing vendor relationship, including capacity planning and quality oversight • Own Prior Authorization turnaround time, coverage rate, and backlog metrics • Build and maintain visibility into team performance for leadership • Drive status tracking and work-list management in Athena and CoverMyMeds • Develop and maintain Prior Authorization competency frameworks, training materials, and SOPs • Partner with clinicians on complex cases and authorization or communication issues • Identify and fix process and tooling breakdowns that create patient-facing failures • Lead hiring, onboarding, and ramp-up of new team members • Report Prior Authorization performance and risk to Central Operations leadership

🎯 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 and an EHR; Athena strongly preferred • Experience managing distributed or blended teams, including vendor management • Track record of building processes and measuring performance with structured tracking and metrics • Strong cross-functional communication skills • Familiarity with GLP-1s or obesity management medications is a strong plus • Must be currently authorized to work in the United States • Must not require, now or in the future, employment visa sponsorship to work in the United States

🏖️ Benefits

• Fully remote opportunity • Medical, dental, and vision insurance • 401K retirement plan with company match • Up to 20 days of PTO per year + company holidays • Up to 14 weeks of parental leave (12 for non-birthing parents) • Annual work from home stipend for remote employees

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