Manager, Prior Authorization

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee and mentor Prior Authorization specialists, focusing on performance management, scheduling, coverage planning, and ensuring staffing continuity.

• Manage the relationship with the outsourced staffing vendor, including capacity planning and quality oversight.

• Take responsibility for Prior Authorization turnaround times, coverage rates, and backlog metrics.

• Create and sustain visibility into team performance for leadership.

• Facilitate status tracking and management of work lists in Athena and CoverMyMeds.

• Develop and uphold Prior Authorization competency frameworks, training materials, and standard operating procedures (SOPs).

• Collaborate with clinicians on complex cases and address authorization or communication challenges.

• Identify and resolve process and tooling issues that lead to patient-facing failures.

• Lead the recruitment, onboarding, and ramp-up processes for new team members.

• Report on Prior Authorization performance and associated risks to Central Operations leadership.

⛳️ Requirements

• 5-7 years of experience in prior authorization.

• 3+ years in a leadership position managing a Prior Authorization or similar insurance-facing operations team.

• In-depth understanding of the Prior Authorization lifecycle and payer requirements.

• Proficiency with CoverMyMeds and an EHR, with a strong preference for Athena.

• Experience managing distributed or blended teams, including vendor management.

• Proven track record of developing processes and measuring performance using structured tracking and metrics.

• Excellent cross-functional communication skills.

• Familiarity with GLP-1s or obesity management medications is a significant advantage.

• Must be legally 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 position.

• Comprehensive medical, dental, and vision insurance.

• 401K retirement plan with company matching contributions.

• Up to 20 days of paid time off (PTO) per year plus company holidays.

• Up to 14 weeks of parental leave (12 weeks for non-birthing parents).

• Annual stipend for remote employees to support work-from-home expenses.