Prior Authorization Manager - Remote US

Location

Anchorage, AK | United States

Job description

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at HMS , a Gainwell Company carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Summary

As a Manager at Gainwell, you will be part of an innovative product company with a mission to serve the healthcare needs of our communities. You will oversee and guide your team to deliver superior service and achieve account goals and outcomes. You manage the performance and engagement of your staff and vendor resources, optimize processes, and maintain the highest quality standards. Your work directly supports the Account Delivery Manager [ADM], Regional Leader, and internal business partners in achieving or exceeding contractual obligations and company goals and objectives.

Your role in our mission

Gainwell empowers you through innovative technologies and solutions to deliver better health and human services outcomes. When joining Gainwell, you will:

• Build, develop, and lead teams of leaders and individual contributors, supporting employees and executing day-to-day operations delivery for an account(s).
• Establish and effectively lead routines regularly and utilize tools and reporting to drive team performance; train and provide ongoing coaching (account-specific metrics, AHT, APT, Occupancy, Utilization, Quality scores, etc.) to ensure employee engagement while maintaining client satisfaction.
• Effectively cultivate relationships with account leaders and business partners to proactively identify and enact opportunities to improve the delivery of operational products, services, and capabilities.
• Work with employees and operational leaders to achieve Client Service Level Agreements (SLAs) and drive accountability and efficiency by adopting standard operating procedures.
• Create conditions for success by removing obstacles and championing change to drive employee awareness and a connection to their work and contributions.
• Identify and manage existing and emerging risks from business activities and implement mitigation strategies to improve performance.

What we're looking for

• Active Registered Nurse license in the United States preferred.
• 7 or more years of people management experience in healthcare.
• Experience in quality assurance to support accurate utilization decisions based upon nationally recognized guidelines and McKesson Interqual Criteria.
• Minimum of two years’ Medicaid experience in Prior Authorization/Utilization Review preferred.
• Proficient with Microsoft Office suite required and experience with software applications to manage contact center and back-office operations preferred.
• Strong written and oral communication and interpersonal skills to work effectively with team members, customers, and clients.
• Demonstrated strategic initiative implementation and execution, specifically with operating policies and procedures and work process improvements in operations.

What you should expect in this role

• Hybrid role with ability to work in the Anchorage, AK office preferred, with the possibility of working remotely from another state for the right candidate .
• The person will need to work Alaska Time hours.

#LI-REMOTE

#LI-LS2

The pay range for this position is $97,500 - $139,300 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at HMS , a Gainwell Company . You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with HMS , a Gainwell Company , an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about HMS , A Gainwell Technologies Company at our  company website and visit our  Careers site for all available job role openings.

HMS, a Gainwell Company is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.

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Salary