Director of Preauthorization & Utilization Strategy

Triple-S Management Corp.; Northern (KY); On-site; USD 100,000 - 140,000; Full time

Job summary

Triple-S Management Corp. is seeking a senior leader to oversee the Preauthorization department.

You will drive strategic planning and daily operations to ensure clinical necessity, cost containment, and timely approvals in line with payer and regulatory requirements. The role requires a Master’s/MHA or higher, 5+ years in prior authorization or revenue cycle, and 3+ years in leadership, with active clinical licensure preferred.

Qualifications

• Bachelor's Degree in Healthcare Administration, Nursing, or a related field is required (Master’s Degree/MHA preferred).
• At least five (5) years of progressive experience in prior authorization, utilization management, or healthcare revenue cycle management.
• At least three (3) years in a dedicated leadership or managerial role overseeing large teams in a utilization management system, preferably in a payer environment.
• Active Clinical Licensure (RN, LVN/LPN, or NP) is highly preferred.

Responsibilities

• Develop and implement cost containment strategies to minimize unnecessary expenditures and denials.
• Align preauthorization workflows with shifting payer policies and regulations.
• Analyze utilization data and denial trends to mitigate risks and improve performance.
• Collaborate with UR, Contracting, Billing, and Clinical leaders to meet financial and clinical goals.
• Lead and mentor a multidisciplinary preauthorization team, setting KPIs and monitoring performance.
• Standardize and automate workflows using EHRs and AI tools for efficiency.
• Ensure adherence to HIPAA, NCQA, URAC, and other regulatory standards.

Skills

Data Driven Insights

Develops Talent

Financial & Business Acumen

One Company Mindset

Practical Knowledge in Tech

Education

Master's in Health Services Administration/Nursing

Bachelor's in Health Services Admin/Nursing

Job description

Triple-S Management Corp. is seeking a senior leader to oversee the Preauthorization department.

You will drive strategic planning and daily operations to ensure clinical necessity, cost containment, and timely approvals in line with payer and regulatory requirements. The role requires a Master’s/MHA or higher, 5+ years in prior authorization or revenue cycle, and 3+ years in leadership, with active clinical licensure preferred.