Description

You will own the flawless execution of high-impact UM programs like Gold Carding and Provider Incentive Programs, ensuring operational soundness, regulatory compliance, and scalability. You will lead cross-functional governance, manage the Prior Authorization List, and develop SOPs for net-new initiatives.

Requirements

• 4+ years in program management
• 3+ years delivering projects/programs
• 2+ years managing prior authorization list process
• Experience in payer/health insurance
• Experience using data and metrics to drive program improvements

Responsibilities

• Lead end-to-end execution and refresh cycles for Gold Card and Provider Incentive programs
• Own the Prior Authorization list, leading cross-functional governance for code updates
• Ensure all UM programs meet state and federal mandates
• Develop and maintain SOPs for net-new initiatives
• Drive recurring refresh cycles for auto-approval rules and provider incentive programs