[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. They are seeking a highly reputed company Clinical Product reputed company and Business Integration reputed company with expertise in clinical prior authorizations to drive a reputed company initiative reputed company on analyzing and redesigning 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 drive 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
reputed company