Sr Manager, Prior Authorizations and Clinical Review

The Kestra team has over 400 years of experience in the external and internal cardiac medical device markets. The

company was founded in 2014 by industry leaders inspired by the opportunity to unite modern wearable technologies

with proven device therapies. Kestra’s solutions combine high quality and technical performance with a wearable design

that provides the greatest regard for patient comfort and dignity. Innovating versatile new ways to deliver care, Kestra is

helping patients and their care teams harmoniously monitor, manage, and protect life.

This key leadership position is accountable for overseeing all aspects of the organization’s prior authorization and clinical

review teams and processes including timely and accurate prior authorization submission and appeal, identifying clinical

relevance within each order as it relates to Local Coverage Determination, communicating outcomes timely and effectively,

trending, and achieving targeted metrics to optimize outcomes. This leader will also be responsible for overseeing and

managing the organization’s third-party vendor relating to aspects of the prior authorization process and will monitor and

validate adherence to Policies and Procedures.

ESSENTIAL DUTIES

• Manage all aspects of the prior authorization and clinical review departments including timely, accurate clinical review, prior authorization submission, and collection of all patient accounts
• Analyzes clinical review and prior authorization outcomes from all sources, including carrier denial exception reporting, first pass approval rate, appeal effectiveness, and clinical relevance rate
• Works across departments to manage the entire process from receipt of patient’s clinical records, prior authorization submission, to final determination
• Liaison with internal departments to promote ongoing communication, and collaboration on cross functional projects related to clinical review and prior authorization optimization
• Ensure that all metrics are being achieved and, when short falls occur, develop actionable plans that will quickly and efficiently resolve the deficit
• Provides department orientation and ongoing training for all in/direct reports
• Responsible for hiring and managing all staff members, along with driving a culture of respect, engagement, accountability, and results
• Adhere to Pledge of Confidentiality
• Information regarding a patient of this company shall not be released to any source outside of this company without the signed permission of the patient. Furthermore, information will only be released internally on a need-to-know basis. All Team Members will not discuss patient cases outside the office or with anyone not employed by this company unless they are directly involved with the patient’s case.

Requirements

COMPETENCIES

• Passion: Contagious excitement about the company – sense of urgency. Commitment to continuous improvement.
• Integrity: Commitment, accountability, and dedication to the highest ethical standards.
• Collaboration/Teamwork: Inclusion of Team Member regardless of geography, position, and product or service.
• Action/Results: High energy, decisive planning, timely execution.
• Innovation: Generation of new ideas from original thinking.
• Customer Focus: Exceed customer expectations, quality of products, services, and experience always present of mind.
• Emotional Intelligence: Recognizes, understands, manages one’s own emotions and is able to influence others. A critical skill for pressure situations.

QUALIFICATIONS

Education/Experience Required:

• Bachelor’s degree
• 7+ years of progressive leadership in the healthcare revenue cycle management function, with an emphasis on clinical review and prior authorization management
• Strong leadership skills aimed at developing high performing teams in a remote environment
• Proven record of achieving aggressive metrics and outcomes

Preferred:

• Master’s degree
• 10+ years of leading revenue cycle management functions

WORK ENVIRONMENT

• Indoor open office environment
• Minimal noise volume typical to an office environment
• Extended hours when needed
• Kestra manufactures and provides life-saving products regulated by the Federal Food and Drug Administration and
• under contract with Medicare. Kestra maintains a drug free workplace and testing is a condition of employment post offer.

PHYSICAL DEMANDS

• Frequent repetitive motions that may include wrists, hands and/or fingers, such as keyboard and mouse usage
• Frequent stationary position, often standing or sitting for prolonged periods of time
• Frequent computer use
• Frequent phone and other business machine use
• Occasional lifting required, up to 15 pounds

TRAVEL

• Minimal domestic travel, but may be required up to 10% of the time

OTHER DUTIES:

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that

are required of the Team Member. Duties, responsibilities, and activities may change or new ones may be assigned at any

time with or without notice.

Benefits

Kestra offers a very competitive benefit package including Medical, Dental, 401K with Match, etc.

Pay equity is an important part of Kestra’s Culture. Our compensation ranges are guided by national and local salary surveys and take into consideration experience level and internal equity. Each role is benchmarked based on the job description provided. If your qualifications and/or experience level are outside of the posted position, we encourage you to apply as we are growing fast and roles that are coming soon may not be posted.

Salary: $145,000 - $155,000

Kestra Medical Technologies is an equal opportunity employer. Kestra Medical Technologies does not discriminate on the basis of race, color, religion, national origin, veteran status, disability, age, sexual orientation, gender identity and/or expression, marital status, or any other characteristic protected by law.

We are unable to sponsor or take over sponsorship of employment visas at this time. Applicants must be eligible to work for any employer in the U.S.

Kestra manufactures and provides life-saving products regulated by the Federal Food and Drug Administration and under contract with Medicare.  Kestra maintains a drug free workplace and testing is a condition of employment.