Manager, Prior Authorization, RN

Job Description: • Oversee the daily operations of the prior authorization team • Ensure timely and accurate processing of authorization requests in compliance with regulatory and payer requirements • Responsible for staff supervision, workflow optimization, performance monitoring, and collaboration with clinical and administrative teams • Lead and manage the prior authorization team, including hiring, training, scheduling, and performance evaluations • Monitor productivity and quality metrics; implement process improvements • Serve as a liaison between providers, payers, and internal departments • Stay current with payer policies, regulatory changes, and industry best practices • Develop and maintain standard operating procedures (SOPs) • Collaborate with clinical leadership to ensure alignment with care delivery goals • Manage escalations related to denied authorizations • Prepare reports and dashboards for leadership on authorization trends, turnaround times, and team performance Requirements: • Registered Nurse (RN) with an active and unrestricted license in state of residence • 5+ years of experience in prior authorization, utilization management, or related healthcare operations • 3-5 years leadership experience • Strong knowledge of payer requirements, medical terminology, and healthcare coding (ICD-10, CPT) • Excellent communication, leadership, and problem-solving skills • Proficiency in EMR systems and authorization platforms • Knowledge of regulations, standards, and policies relating to medical management • Demonstrated ability to manage workload and meet deadlines • Ability to cover weekends at a supervisory capacity Benefits: • Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs including wellness screenings, tobacco cessation and weight management programs • Confidential counseling and financial coaching • Paid time off • Flexible work schedules • Family leave • Dependent care resources • Colleague assistance programs • Tuition assistance • Retiree medical access Apply tot his job Apply To this Job