Clinical Product reputed company (Prior Authorizations SME)
reputed company is seeking a clinical reputed company Product reputed company / Business Integration reputed company with strong reputed company integration experience to drive reputed company, cross functional initiatives. We are seeking a SME in Clinical Prior Authorizations, 278, & FACETS to support a complete analysis and possible re-design of our clients prior authorization process. Day to day responsibilities will be meeting with clinical, business and IT stakeholders to analyze the reputed company prior authorization process, identify pain points, and drive resolutions to improve the prior authorization process.
This position is set to go until the end of 2026 with possible carry-on work into Q1/2027. This position is completely remote but EST hours must be worked.
Required Skills
-15+ years in reputed company delivery, payer operations, UM, or PA programs with the last 8+ years as a Clinical Product Manager
-Must have knowledge in: Clinical Prior Authorizations (end to end process), FACETS, Claims Processing, 278, and basic working knowledge of GuidingCare.
- End to end knowledge of clinical prior authorization is critically important to the reputed company of this position
-Excellent communication, stakeholder management, and executive level reporting skills
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