Authorization Manager

Healthcare Outcomes Performance Company•Phoenix, AZ

2d•Hybrid

About The Position

This is a hybrid leadership position requiring periodic travel and the ability to work within West Coast business hours. Candidates must be flexible and available to support operational needs across multiple locations and time zones. The Authorization Manager will oversee daily operations of the orthopedic authorization department for professional and facility-based services. This role involves managing authorizations for a variety of orthopedic services, leading and developing a large remote authorization team, and ensuring timely submissions, follow-up, and approvals to prevent delays in patient care. The manager will also serve as an escalation point for complex payer issues, collaborate closely with various internal and external teams, and ensure compliance with payer guidelines. Additionally, the position requires analyzing authorization trends, implementing process improvements, maintaining strong knowledge of payer requirements, and developing departmental metrics and reporting.

Requirements

Minimum of 3 years of orthopedic authorization experience REQUIRED
Minimum of 2 years of leadership or management experience overseeing remote teams REQUIRED
Extensive experience with orthopedic procedures, injections, imaging, and surgical authorizations REQUIRED
Facility authorization experience REQUIRED, including hospital and ASC workflows
Proven experience managing high-volume workloads and large remote teams
Demonstrated experience managing productivity metrics, departmental KPIs, and operational accountability
Ability to critically think, solve problems, and make decisions quickly in rapidly changing situations
Ability to pivot priorities with minimal notice while maintaining operational continuity
Ability to independently assess situations, prioritize urgent cases, and make sound operational decisions with minimal direction
Strong knowledge of payer guidelines, medical necessity criteria, authorization portals, and denial prevention strategies
Excellent organizational, communication, and leadership skills
Experience working collaboratively with physicians, executives, operational leadership, and multidisciplinary teams
Strong attention to detail and ability to manage escalated patient care situations effectively
Strong technical proficiency with EMR systems, payer portals, Microsoft Excel, and authorization tracking tools
Must be able to work West Coast time zone business hours
Must be able and willing to travel as operationally needed
Hybrid leadership position with remote and onsite responsibilities
Travel required based on operational and organizational needs
Must maintain availability during West Coast business hours
Fast-paced orthopedic and surgical environment
Requires flexibility to support operational needs, escalations, and urgent patient care situations as they arise
Candidates must be comfortable working in environments where priorities may shift rapidly based on patient care needs, physician schedules, and operational demands.

Nice To Haves

Strong understanding of spine, pain management, and complex orthopedic surgical authorizations preferred
Experience in multi-specialty orthopedic practices
Experience with hospital and ASC revenue cycles workflows
Knowledge of orthopedic and spine coding terminology
Experience with EMR and authorization platforms
Experience with payer audits, medical necessity reviews, and documentation compliance
Athena EMR experience
Strong orthopedic and spine authorization knowledge
Demonstrate operational ownership
Thrive in fast-paced surgical environments
Proven ability to lead remote teams with accountability, urgency, and critical thinking skills
Comfortable working in environments where priorities may shift rapidly based on patient care needs, physician schedules, and operational demands.

Responsibilities

Oversee daily operations of the orthopedic authorization department for professional and facility-based services
Manage authorizations for orthopedic procedures, surgeries, injections, imaging, pain management, and specialty spine cases
Lead, coach, and develop a large remote authorization team while maintaining productivity, quality, accountability, and turnaround time expectations
Monitor authorization workflows to ensure timely submissions, follow-up, and approvals to prevent delays in patient care or surgical cancellations
Serve as an escalation point for complex payer issues, denials, peer-to-peers, and urgent surgical cases
Collaborate closely with surgeons, schedulers, revenue cycle leadership, clinical teams, admitting teams, and facility partners
Ensure compliance with payer guidelines, medical necessity requirements, and authorization timelines
Analyze authorization trends, identify workflow gaps, and implement process improvements
Maintain strong working knowledge of commercial, Medicare Advantage, Medicaid, managed care, and specialty orthopedic payer requirements
Develop and maintain department metrics, productivity standards, operational reporting, and team accountability measures
Monitor authorization aging, pending cases, and scheduling risks to proactively address barriers to care
Assist in creating standardized workflows, escalation pathways, and operational best practices across teams
Support operational readiness for hospital and ASC environments
Communicate operational risks, payer barriers, and escalations to leadership in a timely and solution-focused manner
Maintain a strong culture of communication, urgency, ownership, teamwork, and patient-centered service
Participate in ongoing operational strategy discussions and workflow optimization initiatives