Clinical Product Owner (Prior Authorizations SME)

can reside anywhere in the USA but must work EST hours. (Avoid California)
- Interview Process: 2 video interviews
- Must have: FACETS Claims knowledge 278 prior authorizations knowledge is critical to know basic guideingcare knowledge.
- Seeking a Product / Business Integration Lead / Focused on Prior Authorizations. Lead position
- Seeking 15 years of exp in total 8-10 yrs as a focused Product Owner. NOT looking for an IT product manager seeking a business/clinical Product focused professional with end to end knowledge of prior authorizations
- Need a Product owner to help manage day to day / end to end clinical operations. The team manages the authorizations that come in thru Guidingcare prior authorizations has to be extracted from guidingcare then successfully loaded into Facets. Theyve had issues with this process so they are working with clinical and IT teams to identify fail points and correct them. This PM will support this effort. Plan is already laid out they need someone who can execute the mission. Drive discussions across all claims/IT/Clinical teams to help drive the remaining solutions home
- End to end knowledge of prior authorization is critically important. Need someone who can hit the ground running with limited hand holding and can identify paint points within prior authorization. Deep expertise on how a prior authorization flows.
- GuideingCare is required but just basic knowledge is fine. A lot of the strategy is after the authorization is extracted from GuidingCare so basic knowledge would be very helpful.
- No certifications required
- What is a prior authorization Prior authorization (also known as pre-authorization or precertification) is a cost-control process used by health insurance companies that requires your healthcare provider to obtain advance approval before a specific service treatment or medication is delivered. Without this approval the insurer may refuse to pay for the care potentially leaving you responsible for the full cost.