Authorizations Manager
Zócalo Health
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $110,000 - $120,000 per year
About the role
- Build and lead Zócalo Health’s prior authorization function, establishing operational workflows that support Enhanced Care Management (ECM), Community Supports (CS), Community Health Worker (CHW), Behavioral Health (BH), and Primary Care (PCP) services.
- Design and implement scalable processes for authorization intake, submission, tracking, follow up, and reauthorization management to ensure services are approved and delivered within required payer timelines.
- Hire, develop, and manage a team responsible for authorization operations, including conducting regular 1:1 meetings, coaching for performance and development, and setting clear expectations for quality, timeliness, and accountability.
- Establish operational standards and documentation requirements that ensure compliance with Medi-Cal and managed care plan guidelines, including authorization documentation, submission timelines, and record accuracy.
- Monitor and manage authorization workflows and work queues to ensure requests, reauthorizations, and referrals are processed accurately and efficiently.
- Develop dashboards and reporting tools that track authorization turnaround times, approval rates, reauthorization timelines, and operational performance metrics.
- Analyze trends in authorization outcomes and operational data to identify barriers, improve workflows, and reduce delays that impact patient care or reimbursement.
- Partner closely with Clinical Operations, ECM, Community Supports, Product, and Revenue Cycle teams to ensure authorization processes align with care delivery, documentation requirements, and billing workflows.
- Maintain working knowledge of payer authorization policies and program requirements to ensure workflows remain compliant as health plan guidance evolves.
- Coordinate with health plans and payer representatives to address authorization issues, clarify requirements, and resolve escalations when approvals or timelines are at risk.
- Lead ongoing process improvement initiatives that strengthen operational efficiency, reduce administrative burden, and support high quality service delivery.
- Conduct internal audits and quality checks to ensure authorization accuracy, compliance with program requirements, and adherence to organizational standards.
Requirements
- 5–6+ years of experience in healthcare operations, or care management operations
- Demonstrated experience leading or supervising operational teams in healthcare or managed care environments
- Experience building or improving operational workflows in healthcare operations such as prior authorization, referral management, care coordination, or utilization management
- Strong knowledge of Medicaid or Medi-Cal managed care authorization requirements
- Experience using EHR systems and operational dashboards to manage workflows and performance metrics
- Strong analytical and problem-solving skills with the ability to use data to drive operational decisions.
Benefits
- Equity compensation package
- Comprehensive benefits including medical, dental, and vision
- 401k
- Generous PTO policy (up to 15 days per year for FT employees)
- $1,000 home office stipend
- We provide the equipment needed for this role.
- Opportunity for rapid career progression with plenty of room for personal growth.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
prior authorizationoperational workflowsauthorization intakesubmission trackingreauthorization managementdata analysisoperational performance metricsquality checksprocess improvementcare coordination
Soft Skills
leadershipteam managementcoachingcommunicationproblem-solvinganalytical skillsaccountabilityperformance developmentorganizational skillscollaboration