Senior PA Operations & Clinical Compliance Manager

Medical Mutual; Cleveland (OH); Hybrid; USD 110,000 - 150,000; Full time

Benefits offered by this job

Equipment provided (laptop, monitors,

Job summary

Medical Mutual seeks a Senior Utilization Management leader to oversee daily prior authorization and clinical compliance operations in a hybrid role based at the Brooklyn, OH office. You will coach PA reviewers, monitor KPIs, ensure CMS and NCQA standards, and collaborate with UM, CM, IT, and external partners to maintain compliant, efficient processes.

You will drive operational excellence, prepare reports for leadership, and lead staff development in a fast-paced health plan environment.

Job description

Medical Mutual seeks a Senior Utilization Management leader to oversee daily prior authorization and clinical compliance operations in a hybrid role based at the Brooklyn, OH office. You will coach PA reviewers, monitor KPIs, ensure CMS and NCQA standards, and collaborate with UM, CM, IT, and external partners to maintain compliant, efficient processes.

You will drive operational excellence, prepare reports for leadership, and lead staff development in a fast-paced health plan environment.