Texas Licensed RN Manager

Job Summary

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