Senior Manager Pre-Service Operations

The Senior Manager (SM) is responsible for management of all Pre-Service functions to ensure consistent, efficient delivery of services within the Pre-Service Utilization Management component of the total managed care continuum. The result creates compliance with the client's clinical model, ensures positive outcomes for patients, Health Plans, providers, client peers and other key market stakeholders. This individual is accountable to the Director of Pre-Service Operations in managing overall vertical performance and customer delivery. This includes ensuring appropriate daily execution of all pre-authorizations and Health Plan member transitions as prescribed by utilization models. The ability to work in a variable environment with numerous “up and down stream” dependent groups including our Central Support Operations and strategic offshore clinical partners is mandate for success in this role. Qualifications/Requirements: • Bachelor’s degree; health care related field is preferred • A clinical license (RN, PT, OT) is a plus but is not required for this position • A minimum of 4-6 years of previous managerial experience in a healthcare environment is mandatory – management consulting, operations, clinical care, physician/provider groups, healthcare service companies, health plan • Experienced in use of data/analytics/excel/reporting and uses the tools to drive the day-to-day business • Familiarity with utilization/resource management processes, care/disease management programs • Experience managing multi-disciplinary healthcare teams • Experience in project management and program development/implementation
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