Texas Licensed RN Manager

A company is looking for a Manager of Prior Authorization UM - Aetna Medicaid Texas - RN.

Key Responsibilities

Lead and manage the prior authorization team, including hiring, training, 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

Required Qualifications

Registered Nurse (RN) with an active and unrestricted license in state of residence

5+ years of experience in prior authorization, utilization management, or related healthcare operations

3-5 years of leadership experience

Strong knowledge of payer requirements, medical terminology, and healthcare coding (ICD-10, CPT)

Proficiency in EMR systems and authorization platforms