Manager, Non-Clinical Prior Authorization

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Job description

Avalon Healthcare Solutions, headquartered in Tampa, Florida, is the world's first and only Lab Insights company, bringing together our proven Lab Benefit Management solutions, lab science expertise, digitized lab values, and proprietary analytics to help healthcare insurers proactively inform appropriate care, reduce costs, and improve clinical outcomes. Working with health plans across the country, the company covers more than 36 million lives and delivers 7-12% outpatient lab benefit savings. Avalon is pioneering a new era of value-driven care with its Lab Insights Platform that captures, digitizes, and analyzes lab results in real time to provide actionable insights for earlier disease detection, ensuring appropriate treatment protocols, and driving down overall cost.

Studies show that 30% of clinical laboratory testing is unnecessary or overused. Inappropriate testing or missing a key screening can lead to complications and expense arising from unwarranted care, or not obtaining proper care when needed, leading to increased health risks and costs. Avalon helps ensure delivery of the right test, at the right time, and in the right setting. We seek to ensure the most effective patient treatment, improve clinical outcomes, and optimize cost and affordability.

Avalon is a portfolio company of Francisco Partners, a global private equity firm that specializes in investments in technology and technology-enabled service companies.

Avalon is a high growth company where every associate has an opportunity to make a difference. You will be part of a team that shapes a new market and business. Most importantly, you will help Avalon to achieve its mission and improve clinical outcomes and health care affordability for the people we serve.

For more information about Avalon, please visit .

Avalon Healthcare Solutions is proud to be an equal opportunity employer including disability/veteran. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.

Avalon Healthcare Solutions provides and maintains a drug-free workplace for its employees.

For more about Avalon, please visit our web site at .

About the Manager, Non-Clinical Prior Authorization:

Reporting to the VP, Utilization Management and Quality Improvement, this role manages the day-to-day operations of Avalon's Preservice Intake team to include overseeing call center operations and customer service responsibilities.

This position is eligible for remote work, but quarterly travel to the corporate office in Tampa, Florida is required.

Manager, Non-Clinical Prior Authorization - Essential Functions and Responsibilities:

• Manages the day-to-day operations of Intake Preservice activities to include inventory and inbound calls.
• Acts as primary contact for escalated calls and/or escalated issues for both internal and external partners.
• Participates in the identification, onboarding, and continuous improvement of tools/applications for intake, estimation of resource planning, and associated tracking and monitoring.
• Continuously improves effectiveness and efficiency of the intake processes to adopt best practices and gain operational efficiencies.
• Leads implementations of new health plan clients.
• Hiring and training of new staff.
• Provides mentoring and coaching to the department.
• Develops and maintains training materials to include SOPs.
• Collaborates cross-functionally with internal and external business partners.
• Assists and participates in audits.
• Prepares and presents departmental reports and metrics.
• Collaborates cross-functionally with internal and external business partners.

Manager, Non-Clinical Prior Authorization - Qualifications:

• A minimum of 5 years' experience in health plan operations, plus at least 2 years' experience in people management.
• Bachelor's degree in business management, healthcare administration, or closely related field, or 8 years of direct, applicable experience in lieu of a degree.
• Prior experience running an intake group, call center, or customer service team with a health plan or healthcare vendor.
• Proven management capabilities of a remote, non-exempt production staff.
• Demonstrated ability to drive operational efficiencies through process improvements, scaling operations, and automation.
• Must be able to navigate and master proprietary software programs, also proficient in the use of MS Office suite.
• Ability to lead cross-functional meetings.
• Possess solid analytical capabilities.
• Must have effective written and oral communication skills.

Manager, Non-Clinical Prior Authorization - Preferred Qualifications:

• Experience in a start-up or early-stage private equity held company helpful
• Lean Six Sigma
• PMP certification

PM18

PIf2b9f4e215d5-7970

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