Payor Authorization Operations Manager

We're looking for a passionate and detail-oriented leader to join us as a Payor Authorization Operations Manager. In this role, you will oversee our end-to-end prior authorization and reauthorization processes, managing a dedicated team to ensure 100% compliance and zero lapses in patient care. Reporting to the Care Operations Manager, you will take ownership of our operational pipeline, collaborate cross-functionally to optimize the revenue lifecycle, and serve as the ultimate champion for our families navigating complex state systems.

A strategic authorization operator, you turn complex Massachusetts LTSS and LTHH requirements into seamless patient care. You are equally comfortable navigating regional Medicaid systems and building deep trust with case managers, internal stakeholders, and state agencies to advocate for vulnerable populations. High-agency and process-driven, you have a passion for mentoring staff, analyzing operational metrics, and executing cross-functional work within ambiguous regulatory environments.

This is a Full-Time hybrid opportunity based in Braintree, MA (Boston).

• Master the LTHH landscape: Lead authorization operations for Massachusetts HCBS waiver programs (CHCBS, EBD, SLS, CES, CFC) and Long Term Home Health services, ensuring 100% compliance with HCPF policies and PAR system requirements.

• Oversee end-to-end prior authorization: Own the prior authorization process while leading and managing a team of Doc Collectors and Re-Authorization Associates, maintaining current knowledge of payer requirements.

• Manage reauthorizations: Build out processes and manage the team handling all reauthorization submissions for regional waiver programs and Long Term Home Health services to ensure patients have no lapse in care.

• Coordinate internal lifecycles: Partner with internal teams to troubleshoot and resolve authorization issues impacting the revenue lifecycle, and serve as an expert helping families navigate the appeals process.

• Lead complex case resolution: Serve as the primary escalation point for disputed Medicaid authorizations, appeals, and emergency requests, working directly with HCPF and Acentra (Kepro) to advocate for timely patient care approvals.

• Navigate dual eligibility complexities: Build expertise in Medicaid coordination for beneficiaries and manage intricate authorization scenarios to ensure seamless care transitions.

• Drive team excellence: Create and execute training programs on specific prior authorization requirements, mentor staff on LTHH waiver nuances, and establish performance metrics that drive strong approval rates and sub-10-day processing times.

Success in this role means hitting the ground running as an action-oriented, self-motivated leader who combines absolute operational grit with a deep hunger to optimize processes. You will serve as a master translator of complex healthcare information, seamlessly synthesizing data from various areas into simple, actionable workflows that ensure flawless documentation from initial caregiver touchpoints through to appeals hearings. By staying hyper-aligned with evolving state policies and collaborating cross-functionally, you will make sound, high-stakes decisions that protect both our revenue lifecycle and uninterrupted care for our families.

• 5+ years of Massachusetts Medicaid authorization experience (LTHH, LTSS, or waiver programs) with a proven track record of managing complex authorization portfolios and achieving high approval rates.

• Deep existing knowledge of the regional LTHH ecosystem, including HCPF policies, prior authorization operations, case coordination, and MAPAR systems.

• Expert relationship-building skills with strong communication, problem-solving, and stakeholder management capabilities across state agencies, payer entities, and provider networks.

• High-agency operations background with experience using CRM systems, data analysis, and driving metrics-focused compliance requirements.

• Must reside or be willing to permanently relocate to the Braintree, MA (Boston) area.

• Bachelor's degree in Healthcare Administration, Business, or equivalent field.

• Massachusetts Medicaid certification and LTHH authorization training strongly preferred.