Job Description

About the Role

This is a working leadership role. The PA&R Manager owns the daily operations of the offshore team end to end: queue health, service level attainment, staff scheduling and development, clinic and provider relationships, and continuous improvement. You will report directly to the Clinical PA&R Owner (US-based) and be accountable for the team hitting a 72-hour turnaround SLA KPI with a 24-hour goal.

What You Will Own

1. Day-to-day operations and queue health

• Open and run the daily 15-minute stand-up: WIP by lane, oldest task, staffing gaps, blockers.
• Monitor the Intergy task queue throughout the shift; redistribute work in real time when a lane falls behind.
• Ensure every STAT/P1 order is acknowledged within the same business day and escalated to the US-based PA&R
• Owner immediately; confirm a named handler is reachable for every Pacific-time clinic hour.
• Send a written end-of-shift handoff to the US owner each day covering STAT/P1 activity, stuck tasks, and items needing a US-side decision.
• Own the team's documentation standard: every task note includes status, action taken, confirmation numbers, facility details, and next-action date.

1. Staff scheduling, capacity, and time off

• Build and maintain the team schedule, ensuring shift coverage aligns with Pacific-time clinic hours.
• Manage time-off requests, approvals, and backfill so queue capacity never falls below a safe level; plan around
• Philippine holidays well in advance.
• Track daily productivity per person and per lane; identify when the team needs flex hours or temporary reallocation before a backlog forms.
• Coordinate with the staffing vendor on hiring timelines, onboarding, and backfill for attrition. The vendor SLA targets a defined replacement window; you hold them to it.

1. KPI ownership and SLA accountability

• Own the team's scorecard (detail below) and report to the US PA&R Owner weekly; run a monthly business review with the staffing vendor's account lead.
• Diagnose the root cause when a metric misses: staff skill gap, process failure, clinic-side yield problem, or payer issue, and bring a corrective action with a timeline.
• Maintain a real-time queue health view: green (WIP 1 day of inflow), yellow (1–2 days), red (>3 days or any STAT miss); trigger the escalation ladder the moment the queue hits yellow.
• Track and report first-pass yield by clinic and provider; flag low-yield clinics to the US owner for targeted education.

1. Team development, training, and quality

• Lead structured onboarding for new staff using lane-certification curriculum (Foundations Systems Wave 1 triage/referral-only Wave 2 auth/med PA/pending Wave 3 exceptions).
• Conduct QA audits: 100% review during a new employee's first 50 tasks in each lane, dropping to a steady-state sample once certified; monthly calibration sessions with all staff.
• Administer 30/60/90-day lane certifications and the 6- and 12-month competency assessments; maintain records for each staff member.
• Coach staff on payer rules, clinical documentation requirements, and return-to clinic standards; escalate persistent gaps as training needs to the US owner.
• Identify candidates within the team for the exceptions lane and senior specialist progression.

1. Process adherence and continuous improvement

• Enforce SOPs without exception: one task per order, real-time documentation, templated return-to-clinic notes
• with exact missing items, no work outside the Intergy queue.
• Surface recurring payer, clinic, or system issues to the US owner with supporting data, not just anecdotes.
• Participate in SOP update reviews; flag steps that do not match what staff encounter in practice.
• Support Oracle EHR migration activities as directed; ensure the team's workflow documentation stays current through system changes.

What You Need to Bring

Required

• 3+ years leading a healthcare revenue cycle or managed care operations team of 10 or more staff, with direct accountability for service level attainment.
• Demonstrated referral and prior authorization experience: working knowledge of referral coordination, medical prior auth, and medication PA (including step therapy), across commercial PPO/HMO, Medicare/Medicare
• Advantage, Medicaid/managed Medicaid, and government program plans (TriCare, VA Community Care).
• KPI-driven management style: you have owned a scorecard, diagnosed misses, and delivered corrective actions with measurable results — bring examples.
• Scheduling and capacity management: experience building team schedules across time zones, managing leave coverage, and adjusting real-time allocation when volume spikes.
• EHR task queue fluency: comfort working in a structured task-based EHR system (Intergy by Greenway experience is a strong plus; comparable systems are acceptable).
• Strong written English: all documentation, patient and provider notes, and US-stakeholder communication is in written English.

Working Conditions:

• can work Onsite
• Availability during Pacific-time business hours: the team must maintain live coverage for STAT escalations during Pacific clinic hours (approximately 8 AM–5 PM PT); shift structure is negotiable but coverage is not.