Manager, Prior Authorization Oversight - Remote

Overview

The Manager of Prior Authorization Oversight acts as a subject matter expert on prior authorization and appeals operations, ensuring compliance with federal, state, and other regulatory standards for various lines of business.

In Short

• Develop and maintain prior authorization policies and procedures.
• Ensure compliance with URAC, NCQA, and other accrediting bodies.
• Oversee utilization management turnaround times.
• Work with PA managers to revise job aids and documents.
• Develop compliant prior authorization notifications.
• Represent the PA team on regulatory audits.
• Support on data validation audits.
• Ensure compliance of the prior authorization system.
• Collaborate with the Senior Director on various projects.
• Adhere to the Capital Rx Code of Conduct.

Requirements

• Active, unrestricted pharmacist license required.
• 1+ years prior authorization review or appeals experience.
• 2+ years of compliance or regulatory experience.
• Extensive knowledge of Medicare, ERISA, and state regulations.
• Strong oral and written communication skills.
• Intermediate to advanced Microsoft Excel skills.

Benefits

• Flexible position description for organizational goals.