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Kestra Medical, a cardiac medical device company founded in 2014, is seeking a Manager of Prior Authorizations to lead all aspects of the organization's prior authorization team and processes. This leadership role oversees timely and accurate prior authorization submissions, renewals, extensions, follow-ups, and appeals, including requests for single case agreements and gap exceptions. The manager will analyze clinical review and prior authorization outcomes from all sources, including carrier denial exception reporting, first pass approval rates, appeal effectiveness, and clinical relevance metrics.
Key responsibilities include managing the entire prior authorization workflow from receipt of patient clinical records through final determination, liaising with internal departments to promote cross-functional collaboration on optimization initiatives, and ensuring all metrics are achieved with actionable plans to resolve any deficits. The role requires active engagement in automation opportunities, workflow improvements, and efficiency gains to minimize revenue leakage.
The manager will oversee third-party vendors related to the prior authorization process, monitor adherence to policies and procedures, and manage all staff members within the department. This includes conducting performance reviews, providing feedback, setting professional development goals, and driving a culture of respect, engagement, accountability, and results.
Required qualifications include a bachelor's degree and 3-5 years of leadership experience in healthcare revenue cycle management with a focus on prior authorization. Candidates must demonstrate a strong understanding of clinical review and prior authorization management, with a proven record of achieving aggressive metrics and outcomes. Preferred experience includes 10+ years leading revenue cycle management functions and experience with vendor management or offshore staff augmentation relationships.
The position is fully remote but operates in a fast-paced environment with extended hours when needed. Kestra manufactures FDA-regulated, life-saving products under Medicare contract and maintains a drug-free workplace with testing as a condition of employment.
