Authorization Manager

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.

ESSENTIAL FUNCTIONS

• 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

EDUCATION

Bachelor’s degree in healthcare administration, business, or a related field preferred. Equivalent revenue cycle and authorization management experience may be substituted for a four-year degree. Candidates with demonstrated leadership success in orthopedic or surgical authorizations, payer relations, and healthcare operations are strongly encouraged to apply.

EXPERIENCE

• 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
• Strong understanding of spine, pain management, and complex orthopedic surgical authorizations preferred
• 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

REQUIREMENTS

• 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

KNOWLEDGE

• Experience in multi-specialty orthopedic practices
• Experience with hospital and ASC revenue cycle workflows
• Knowledge of orthopedic and spine coding terminology
• Experience with EMR and authorization platforms
• Experience with payer audits, medical necessity reviews, and documentation compliance
• Bachelor’s degree is preferred but not required based on experience
• Athena EMR experience

SKILLS

• List required skills applicable to this position

ABILITIES

Ideal candidates will possess strong orthopedic and spine authorization knowledge, demonstrate operational ownership, thrive in fast-paced surgical environments, and have a proven ability to lead remote teams with accountability, urgency, and critical thinking skills.

Candidates must be comfortable working in environments where priorities may shift rapidly based on patient care needs, physician schedules, and operational demands.                                                                                                                        

ENVIRONMENTAL WORKING CONDITIONS

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

PHYSICAL/MENTAL DEMANDS

Candidates must be comfortable working in environments where priorities may shift rapidly based on patient care needs, physician schedules, and operational demands.

ORGANIZATIONAL REQUIREMENTS

• HOPCo Mission, Vision and Values must be acknowledged and adhered to
• List additional organization requirements such as training conducted by organization