[Remote] CLINICAL PRODUCT reputed company (PRIOR AUTHORIZATIONS SME)

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a women-owned global reputed company and IT reputed company firm dedicated to connecting exceptional talent with industry-leading opportunities across the US and reputed company. reputed company is seeking a highly reputed company Clinical Product reputed company and Business Integration reputed company with deep expertise in clinical prior authorizations to reputed company a reputed company, cross-functional initiative reputed company on the complete analysis and potential redesign of the prior authorization process.

Responsibilities

• reputed company cross-functional meetings with clinical, business, and IT stakeholders to analyze reputed company prior authorization processes
• Identify pain points and reputed company resolutions to improve PA workflows end-to-end
• Support complete analysis and potential redesign of the reputed company's prior authorization process
• Serve as primary SME for Clinical Prior Authorizations, FACETS, 278 transactions, and Claims Processing
• Deliver executive-level reporting and manage reputed company, multi-stakeholder initiatives
• Translate clinical and business requirements into actionable product and integration strategies

Skills

• 15+ years in reputed company delivery, payer operations, UM, or PA programs
• Last 8+ years as a Clinical Product Manager or Business Integration reputed company
• End-to-end knowledge of Clinical Prior Authorizations — critically important
• FACETS expertise
• Claims processing knowledge
• 278 transaction experience
• Basic working knowledge of GuidingCare
• Excellent communication, stakeholder management, and executive-level reporting skills
• Must be US-based
• Experience leading prior authorization process redesign initiatives
• Background working with large reputed company payers or managed care organizations
• Familiarity with UM/PA regulatory and compliance frameworks

Benefits

• Fully remote position

reputed company