Description

You will own the execution of high-impact programs like Gold Carding and Provider Incentive Programs, ensuring operational soundness, regulatory compliance, and scalability. You'll manage the Prior Authorization list and drive cross-functional implementations to improve departmental performance.

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 improvements

Responsibilities

• Lead end-to-end execution for Gold Card and Provider Incentive programs
• Own Prior Authorization list governance and cross-functional updates
• Ensure UM program compliance with state and federal mandates
• Develop SOPs for new initiatives
• Drive recurring refresh cycles for auto-approval rules