Manager of Prior Authorization - Aetna Medicaid Texas - RN - Remote

Overview

The Manager of Prior Authorization oversees the daily operations of the prior authorization team, ensuring timely and accurate processing of authorization requests in compliance with regulatory and payer requirements.

In Short

• Lead and manage the prior authorization team.
• Ensure timely review and processing of prior authorization requests.
• Monitor productivity and quality metrics.
• Serve as a liaison between providers, payers, and internal departments.
• Stay current with payer policies and regulatory changes.
• Develop and maintain standard operating procedures for workflows.
• Collaborate with clinical leadership.
• Manage escalations related to denied authorizations.
• Prepare reports and dashboards for leadership.

Requirements

• Registered Nurse (RN) with an active license.
• 5+ years of experience in prior authorization or healthcare operations.
• 3-5 years of leadership experience.
• Strong knowledge of payer requirements and medical terminology.
• Excellent communication and problem-solving skills.
• Proficiency in EMR systems.
• Ability to manage workload and meet deadlines.
• Ability to cover weekends at supervisory capacity.

Benefits

• Affordable medical plan options.
• 401(k) plan with company matching.
• No-cost wellness programs.
• Flexible work schedules.
• Tuition assistance.
• Paid time off and family leave.
• Employee stock purchase plan.
• Confidential counseling and financial coaching.