Manager, Prior Authorization UM
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Position Summary
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. This role is responsible for staff supervision, workflow optimization, performance monitoring, and collaboration with clinical and administrative teams to support patient access and care coordination.
This is a fully remote position. Eligible candidates may live anywhere in the contiguous United States.
Key Responsibilities:Lead and manage the prior authorization team, including hiring, training, scheduling, and performance evaluations.
Ensure timely review and processing of prior authorization requests for medical services, procedures, and medications.
Monitor productivity and quality metrics; implement process improvements to enhance efficiency and accuracy.
Serve as a liaison between providers, payers, and internal departments to resolve authorization issues.
Stay current with payer policies, regulatory changes, and industry best practices.
Develop and maintain standard operating procedures (SOPs) for prior authorization workflows.
Collaborate with clinical leadership to ensure alignment with care delivery goals.
Manage escalations related to denied authorizations.
Prepare reports and dashboards for leadership on authorization trends, turnaround times, and team performance.
Required Qualifications
Registered Nurse (RN) with an active and unrestricted licene in state of residence
5+ years of experience in prior authorization, utilization management, or related healthcare operations.
3-5 years leadership experience
Strong knowledge of payer requirements, medical terminology, and healthcare coding (ICD-10, CPT).
Excellent communication, leadership, and problem-solving skills.
Proficiency in EMR systems and authorization platforms.
Knowledge of the regulations, standards, and policies which relate to medical management
Demonstrated ability to manage workload and meet deadlines
Ability to cover weekends at supervisory capacity
Preferred Qualifications
3-5 years Managed Care expeirence
Experience with Medicare, Medicaid, and commercial insurance plans.
Familiarity with NCQA accreditation standards.
Education
Registered Nurse, BSN preferred
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$87, $187,460.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
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We anticipate the application window for this opening will close on: 11/01/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.