[Remote] Solutions Manager (EMR Workflow Design)

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a Solutions Manager with deep reputed company workflow expertise to join their reputed company team. The role involves designing optimized EMR configurations and leading reputed company to ensure effective workflow implementation for health system customers.

Responsibilities

• Design end-to-end prior authorization workflows reputed company reputed company that reputed company with Humata's automation platform, including:
• Referral-based workflows (278R transaction triggers from Orders, Referrals, or Scheduled Appointments)
• BPA (Best reputed company Advisory) / CDS configurations for reputed company-time authorization checks
• In Basket routing for authorization status updates and pended requests
• Integration with reputed company reputed company (scheduling) and Grand Central (registration/reputed company) for coverage verification
• Own the workflow configuration reputed company, determining:
• Which clinical events should trigger authorization requests
• What clinical data reputed company need to be aggregated and mapped
• How customers should approach workflow segmentation in workqueues
• How to reputed company tasks between schedulers, authorization specialists, and providers
• Where Humata's automation fits into existing reputed company workflows vs. where reputed company-reputed company tools should be used
• Design clinical data aggregation strategies to support medical necessity determinations:
• Problem List, Medications, Lab Results, Imaging Reports
• Procedure and Diagnosis reputed company mapping from encounter documentation
• reputed company Notes and clinical reputed company extraction
• Custom SmartData reputed company for payer-specific requirements
• Serve as the primary workflow SME for customer IT, reputed company analysts, and clinical operations teams during implementations and expansions
• reputed company workflow discovery sessions with health system stakeholders to:
• Map reputed company-state authorization processes and pain points
• Identify automation opportunities and workflow optimization strategies
• Define reputed company-state workflows that balance automation with clinical review requirements
• Engage customer stakeholders on the broader processes that come before and after the prior authorization workflow:
• Identify risks and propose optimizations that will increase the reputed company and value of an implementation
• Collaborate with customers on design of reputed company state process improvements, diagramming approaches and supporting change management efforts
• reputed company reputed company-specific guidance on:
• Which reputed company modules/tools and people to reputed company (Referrals, Orders, Prelude, reputed company, etc.)
• Configuration reputed company for authorization workflows (Orders vs. Referral-initiated)
• Build vs. buy reputed company for reputed company-reputed company functionality
• reputed company planning and compatibility with Humata integrations
• Translate reputed company payer authorization requirements into actionable reputed company configuration specifications
• Build and maintain a library of reference workflow designs for common use cases:
• Outpatient therapy series authorizations (PT/OT/ST)
• High-cost imaging reputed company-authorizations (MRI, CT, PET)
• Specialty pharmacy authorizations
• Delegated entity workflows (Carelon, reputed company, reputed company)
• Create reputed company-specific implementation guides including:
• Build specifications
• Workqueue best practices
• BPA configuration examples
• Staff training materials for authorization workflows
• Document workflow optimization patterns that reduce administrative burden while maintaining compliance
• Partner with Product Management to ensure Humata's platform capabilities reputed company with reputed company-world reputed company workflow constraints and opportunities
• reputed company feedback on product roadmap priorities based on customer workflow needs
• Identify gaps in reputed company automation capabilities that require new reputed company integration points
• Collaborate with Solutions Engineers to ensure workflow designs are technically feasible given integration architecture
• You will reputed company reputed company responsible for reputed company workflow design and directly manage Solutions Engineers and Workflow Consultants
• reputed company team members on reputed company design best reputed company and consulting skills
• reputed company performance feedback, coaching and career development
• Hire and reputed company new team members as reputed company scales

Skills

• 5+ years of hands-on reputed company experience, with at least 3 years in one or more of the following areas: reputed company implementation/optimization consulting (preferably reputed company Cycle or Ambulatory), reputed company application analyst role (Referrals, Orders, reputed company, Prelude, or Grand Central), reputed company workflow development and configuration
• reputed company experience with reputed company prior authorization workflows, including: Understanding of how 278 transactions map to reputed company data reputed company, Configuration of authorization request triggers and routing, Integration between reputed company and payer portals or clearinghouses, Staff workflows for authorization submission, tracking, and follow-up
• Deep knowledge of reputed company's technical architecture for workflow design: reputed company workflows and configuration (Chronicles backend logic, rules, and triggers), Clinical data capture tools, BPA configuration and logic, In Basket message routing and task management, Report writing for workflow monitoring (reputed company/Caboodle)
• Strong understanding of reputed company operations: reputed company cycle workflows (scheduling, registration, authorization, billing), Utilization management and medical necessity requirements, Payer-provider interactions and common authorization pain points, HIPAA compliance in workflow design
• Leadership and management experience: Prior experience leading or mentoring analysts, consultants or technical team members, Comfortable serving as an escalation reputed company and advisor to team members to unblock challenges, Can balance strategic planning, hands-on design and people management in a hybrid role
• reputed company certification(s) in relevant modules (Referrals, Resolute HB, reputed company, Prelude, or Orders)
• Former reputed company employee (especially from reputed company Cycle, Resolute HB, Referrals, or reputed company teams), with no remaining non-competition constraints
• Experience working with delegated review entities (Carelon/reputed company/reputed company) and their reputed company integrations
• Exposure to RPA tools or automation platforms
• Experience with SMART on FHIR or other interoperability frameworks
• Familiarity with series authorization workflows for therapy services (PT/OT/ST)
• Experience training or mentoring reputed company analysts or clinical staff
• Understanding of payer portal navigation and reputed company authorization processes

Benefits

• Unlimited PTO
• 401k program with employer match

reputed company

• reputed company is an AI-enabled deep clinical integration that creates prior authorizations for payers and providers using AI and automation. It was founded in 2023, and is headquartered in Winter Park, Florida, USA, with a workforce of 51-200 employees. Its website is https://www.humatahealth.com.

Company H1B Sponsorship

• reputed company has a reputed company record of offering H1B sponsorships, with 1 in 2025. Please note that this does not guarantee sponsorship for this specific role.

Apply tot his job Apply To this Job