Manager, Business Operations - Prior Authorizations

Manager, Business Operations - Prior Authorizations

Manages strategic business planning and development by owning the development and execution of strategies for gathering data to achieve business objectives in alignment with key business decisions. Drives project execution and management by managing team members to collaborate with stakeholders across functions and driving the application of strategies to ensure expectations are met. Leads process monitoring and improvement by managing team members to perform routine and complex processes and defining requirements. Manages legal, regulatory, and compliance adherence by managing teams to ensure others are provided with information on new or updated organizational and departmental policies, guidelines, and procedures. Manages the development of policies and procedures by facilitating the development of policies and procedures pertaining to applicable functions and scope. Manages training efforts for customers by managing team members who develop training requirements to ensure compliance with regulatory and internal standards.

Essential Responsibilities :

• Provides developmental opportunities for others; builds collaborative, cross-functional relationships. Solicits and acts on performance feedback; works closely with employees to set goals and provide open feedback and coaching to drive performance improvement. Pursues professional growth; develops and provides training and development to talent for growth opportunities; supports execution of performance management guidelines and expectations. Leads, adapts, implements, and stays up to date with organizational change, challenges, feedback, best practices, processes, and industry trends. Fosters open dialogue amongst team members, engages, motivates, and promotes collaboration within and across teams. Delegates tasks and decisions as appropriate; provides appropriate support, guidance, and scope; encourages development and consideration of options in decision making.
• Manages designated work unit or team by translating business plans into tactical action items; oversees the completion of work assignments and identifies opportunities for improvement; ensures all policies and procedures are followed. Aligns team efforts; builds accountability for and measuring progress in achieving results; determines and ensures processes and methodologies are implemented; resolves escalated issues as appropriate; sets standards and measures progress. Fosters the development of work plans to meet business priorities and deadlines; obtains and distributes resources. Removes obstacles that impact performance; identifies and addresses improvement opportunities; guides performance and develops contingency plans accordingly; influences teams to execute in alignment with operational objectives.
• Manages strategic business planning and development by : owning the development and execution of strategies for data management and defining initiatives to achieve business objectives, which may include : writing grant proposals and conducting and publishing research, in alignment with key business decisions; organizing, leading, and defining project inputs, requirements, potential risks, and success metrics in strategic business objectives and outcomes, as well as managing larger teams and complex initiatives; and managing team members to collaborate cross-functionally to align on the project scope, and complex and long-term project deliverables and timelines for department initiatives.
• Directs project execution and management efforts by : developing relations with senior management to enable collaborations with stakeholders across functions and organizations to ensure the project is executed and project-based changes are implemented; developing advanced strategies to ensure expectations around tracking, reporting, and coordinating project-related activities are met and risks and issues (e.g., financial forecasting) are identified and escalated, and engaging others on the organization to implement them; and owning the development of advanced strategies focused on client and stakeholder relationships to ensure that all project-related expectations are clarified, understood, documented, met (e.g., coordinating logistics, and preparing meeting agendas and materials), and engaging others on the organization to implement them.
• Directs process monitoring and improvement by : leading supervisors and managers to connect the departmental results and objectives to cross-functional business partners and defining process requirements using strategic intent; directing team members to maintain, optimize, and transform highly complex and long-term processes for enterprise initiatives to increase efficiency of systems, which may include : maintaining benefit plans, ensuring new benefit plans or changes to existing benefit plans have been implemented successfully; directing team members to develop research plans that identify new and / or existing business operating models and innovative approaches to solutions support (e.g., new care delivery models, improving access to care and clinical care delivery); developing advanced strategies to collect data to determine the nature and requirements of process related improvements; determining strategy for stakeholder engagement and communication throughout projects to ensure teams are aligned to gather information and implement process improvements; and directing the preparation of documentation to communicate updates, changes, or adjustments to function-wide systems, processes, accreditation, or compliance.
• Manages legal, regulatory, and compliance adherence by : managing teams to ensure others are provided with information on new or updated organizational and departmental policies, guidelines, procedures, which may include : conducting bill / claim audits, assessing policy / procedure violations to claims, recording audit findings; and driving others to perform complex and long-term project related work in accordance with established federal, state, and local policies, guidelines, procedures, laws, regulations (e.g., federal, state and contractual leaves of absence, Americans with Disabilities Act Amendments Act, Workers compensation, and Return to Work issues to employees and managers), collective bargaining agreements, and within established service expectations.
• Manages efforts to develop policies and procedures by : facilitating the development of policies and procedures pertaining to applicable functions and scope so that they reflect best practice, quality, and adhere to regulatory requirements; and managing team members who apply strategies to write internal, function-level policies that adhere to departmental, organizational, and industry guidelines, and standards.
• Manages training efforts for customers by : managing team members who develop training requirements to ensure compliance with regulatory and internal standards; managing team members who develop training programs for stakeholders and ensuring relevant training certifications are up to date and valid; and driving others to develop complex and long-term project-based training curriculum for a wide variety of operations related activities.

Minimum Qualifications :

Additional Requirements :

Preferred Qualifications :