Senior Medical Review Director - Stop Loss Focus

Medical Review And Prior Authorization Program Manager

Lead, organize, and develop staff in administration of the Medical Review and Prior Authorization programs for government programs. This role Directs and oversees the Medical Review and Prior Authorization programs ensuring performance expectations, compliance standards, workload issues, quality control, training and maintaining effective staffing levels and budgetary limits are maintained per the Center for Medicare and Medicaid Service (CMS) guidelines. Guides the Medical Review Team in the development and implementation of an efficient and effective Medical Review Strategy, including the integration of policy and education, that optimizes critical Medical Review cycle times. Serves as the Medical Review and Prior Authorization liaison between internal and external stakeholders.

This is a remote position. Typical work hours are from 8:30am - 5pm, Monday through Friday.

To qualify for this position, you'll need the following:

• Required Education: Bachelor's in a job related field
• Required Work Experience: 10 years healthcare program management, utilization/case management, or medical review management or equivalent military experience in grade E4 or above.
• Required Skills and Abilities: Excellent verbal and written communication skills. Excellent organizational, customer service, analytical or critical thinking skills. Excellent presentation skills. Good judgment skills. Ability to persuade, negotiate, or influence others. Ability to evaluate existing processes and develop ways to streamline procedures. Strong organizational, analytical, communication, and decision-making skills. Knowledge of budget preparation and management. Ability to handle difficult situations. Ability to easily adapt to change.
• Required Software and Other Tools: Microsoft Office. Knowledge of medical systems software.
• Required Licenses and Certificates: If RN, active RN licensure in state hired.

Our comprehensive benefits package includes the following:

• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more