Prior Authorization Manager

OakLeaf Clinics - Business Office

OakLeaf Clinics - Business Office has an exciting opportunity for a full-time prior authorization manager to join our expanding team.

OakLeaf Clinics is dedicated to providing our patients with compassion, trust, and a lifetime of individualized care. Our healthcare team consists of physicians, nurse midwives, nurse practitioners, physician assistants, dietitians, nurses, respiratory therapists, and medical assistants working in concert with laboratory/imaging services to offer individualized care to the Chippewa Valley.

Position description

As the prior authorization manager, you are responsible for leading the daily operations, clinical oversight, and administrative functions of the prior authorization team. You will collaborate closely with physicians, advanced practice providers, clinic personnel, the revenue cycle team, and health plan representatives to ensure timely, accurate, and compliant processing of authorization requests.

In this role, you will help drive patient access to care, reduce avoidable delays, and support optimal reimbursement outcomes. Your primary responsibilities include managing staff performance, streamlining workflows, upholding payer and regulatory standards, and optimizing the overall effectiveness of the prior authorization process.

Responsibilities

• Lead day-to-day operations of the clinical prior authorization team, ensuring efficiency, accuracy, and adherence to turnaround times
• Oversee the review and submission of prior authorization requests across multiple service lines, ensuring appropriate clinical documentation and alignment with payer policies
• Develop strong, collaborative relationships with clinical providers, revenue cycle teams, and external insurance contacts
• Maintain and communicate up-to-date knowledge of payer-specific criteria for medical guidelines, and appeal processes
• Evaluate and manage staffing levels and scheduling to meet service needs and minimize processing delays
• Identify and implement process improvements to reduce denials and streamline workflows
• Follow and enforce adherence to organizational policies, HIPAA guidelines, and regulatory requirements
• Develop, review, and update policies and procedures related to prior authorization processes
• Conduct regular staff meetings and individual check-ins to communicate updates, provide feedback, and support professional development
• Monitor key performance indicators and conduct audits to assess quality and compliance
• Resolve escalated patient or provider concerns related to authorizations or access to care
• Prepare and conduct performance evaluations, set goals, and assist in professional growth plans
• Collaborate with IT and system vendors to optimize EMR/authorization tools and workflows
• Partner with HR to ensure all staffing, performance management, and disciplinary actions are handled appropriately
• Ensure timely approval of staff timecards and communicate payroll changes accurately
• Participate in internal management team meetings and contribute to organization-wide initiatives
• Additional duties may be assigned

Qualifications

• Bachelor's degree in healthcare administration, nursing, or related field (preferred)
• Three years of experience in prior authorization, utilization review, or managed care
• Two years of supervisory or management experience (preferred)
• Working knowledge of insurance guidelines, clinical review criteria, and appeal processes
• Excellent interpersonal communication, problem-solving, and conflict resolution skills
• Ability to lead, train, and motivate a team in a fast-paced, deadline-driven environment
• Strong analytical skills and attention to detail for evaluating authorizations and workflows
• High emotional intelligence with the ability to navigate complex interpersonal dynamics and resolve sensitive issues
• Familiarity with the EPIC EMR system, payer portals, and prior authorization platforms
• ACS-certified (Prior Authorization Certified Specialist Program (PACS)); If not certified, expectation of certification within one year of hire.

Work environment

While performing the duties of this job, the employee regularly works in an office setting, with the potential to work a hybrid schedule.

Physical demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is occasionally required to walk; sit; use hands or fingers to grasp, handle, objects, tools, or controls; reach with hands and arms; stoop, kneel, or crouch; talk or hear. The employee must occasionally lift or move up to 20 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Salary: Salary starting at $65,000
Education: Bachelors
Job Type: Full Time
Experience: 2+ years
Location: 719 W Hamiliton Ave • Eau Claire, WI 54701

To apply, please send cover letter and resume to:

Carissa Eppens, Human Resources Administrative Assistant

OakLeaf Clinics
719 W Hamilton Ave, Suite B, Eau Claire, WI 54701

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