RCM - Operations Manager

The Healthcare Operations Manager - Patient Access & Authorization is responsible for the overall management, performance, quality, and operational effectiveness of patient access functions, including pre-certification, prior authorization, insurance verification, benefits coordination, and related authorization support services.

This role provides strategic and operational leadership to supervisors, team leads, and healthcare operations staff supporting high-volume authorization workflows. The Manager ensures that processes are efficient, compliant, patient-centered, and aligned with organizational and client objectives.

The position serves as a senior operational escalation point for complex payer, authorization, workflow, and service issues and works closely with clinical teams, physicians, scheduling, patient access leadership, payers, revenue cycle, quality, workforce management, and other stakeholders.

The Healthcare Operations Manager will also support new program implementation, operational transition, process standardization, workforce planning, performance improvement, and the establishment of scalable healthcare operations, particularly in a start-up or rapidly growing environment.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Provide overall operational leadership for Patient Access and Benefits & Authorization functions, ensuring efficient and timely completion of high-volume workflows.
• Manage and develop Supervisors, Team Leads, and operational teams, establishing clear performance expectations, accountability, and leadership development plans.
• Oversee authorization and pre-certification operations for orthopedic services, including surgical procedures, PM&R services, and ancillary services such as MRI, DME, Visco Supplementation, and EMG testing.
• Establish and monitor operational KPIs, including productivity, turnaround time, quality, accuracy, service levels, authorization outcomes, denial rates, and other business-critical metrics.
• Analyze operational performance data to identify trends, capacity gaps, process risks, and opportunities for improvement.
• Develop and execute action plans to address performance gaps and improve operational efficiency, quality, and patient access outcomes.
• Provide senior-level escalation support for complex authorization issues, payer disputes, urgent requests, denials, medical necessity concerns, and other operational barriers to patient care.
• Ensure consistent application of payer requirements, medical necessity guidelines, CPT, ICD-10, clinical documentation standards, and organizational policies.
• Partner with physicians, clinical teams, scheduling, front-end operations, revenue cycle, payers, and leadership to minimize authorization-related delays, denials, cancellations, and appointment disruptions.
• Oversee the development, implementation, and maintenance of standardized workflows, SOPs, policies, process maps, training materials, and operational guidelines.
• Ensure accurate and compliant documentation of authorization activities, payer communications, reference numbers, outcomes, follow-ups, and other required information within EHR and authorization systems.
• Establish quality assurance and audit programs to ensure compliance with organizational standards, payer requirements, and applicable regulatory requirements.
• Lead continuous improvement initiatives focused on process efficiency, automation, quality improvement, cost optimization, and enhanced patient and provider experience.
• Identify opportunities to streamline authorization workflows, eliminate unnecessary manual processes, reduce rework, and improve turnaround times.
• Partner with Workforce Management and leadership to develop staffing models, capacity plans, schedules, productivity targets, and coverage strategies based on operational demand.
• Participate in workforce planning, recruitment, onboarding, performance management, succession planning, and leadership development.
• Provide regular operational reporting and business updates to senior leadership, including performance trends, risks, staffing requirements, improvement initiatives, and recommendations.
• Lead or support implementation, transition, migration, and operational readiness activities for new healthcare programs, services, clients, or processes.
• Coordinate cross-functional activities during new program launches and ensure operational requirements, staffing, training, systems, workflows, and performance measures are established before go-live.
• Establish appropriate governance, communication, escalation, and reporting structures to support stable operations.
• Manage operational risks and issues, ensuring timely identification, escalation, resolution, and documentation.
• Build strong relationships with internal and external stakeholders and serve as a key point of contact for operational matters.
• Promote a culture of accountability, collaboration, continuous improvement, quality, and patient-centered service.
• Ensure leadership teams are aligned on organizational priorities, operational changes, payer updates, and process requirements.
• Conduct regular operational reviews with supervisors and leadership to evaluate performance and establish improvement priorities.
• Support strategic initiatives and other projects assigned by senior leadership.
• Perform other duties as assigned.

QUALIFICATIONS

EDUCATION AND EXPERIENCE

• Bachelor’s degree in Healthcare Management, Business Administration, Nursing, Allied Health, or a related field required; advanced degree preferred.
• Minimum of 5-7 years of experience in healthcare operations, patient access, prior authorization, pre-certification, insurance verification, revenue cycle, or a related healthcare environment.
• Minimum of 3 years of experience in a people management or operational leadership capacity, preferably managing supervisors or multiple teams.
• Strong experience managing high-volume healthcare operations and performance-driven teams.
• Experience overseeing prior authorization, pre-certification, benefits, eligibility, or patient access functions strongly preferred.
• Orthopedic, hospital, physician practice, centralized patient access, or multi-specialty healthcare experience preferred.
• Experience supporting new program implementation, start-up operations, transition, migration, or operational transformation is highly preferred.
• Strong understanding of payer requirements, medical necessity guidelines, authorization processes, denial prevention, and healthcare workflows.
• Working knowledge of CPT, ICD-10, medical terminology, and clinical documentation requirements.
• Proficiency with EHR systems, payer portals, authorization platforms, work queues, reporting systems, and Microsoft Office applications.
• Demonstrated experience using operational data and performance metrics to drive business decisions and process improvements.
• Strong knowledge of quality, compliance, and healthcare regulatory requirements.
• Excellent leadership, stakeholder management, communication, analytical, organizational, and problem-solving skills.

CORE SKILLS AND COMPETENCIES

• Healthcare Operations Leadership
• Patient Access & Authorization Management
• People & Leadership Development
• Performance & Productivity Management
• Quality Assurance & Compliance
• Process Improvement & Optimization
• Workforce Planning
• Operational Readiness & Implementation
• Change & Transition Management
• Data Analysis & Business Reporting
• Risk & Issue Management
• Stakeholder & Client Management
• Strategic Planning
• Conflict Resolution & Escalation Management
• Project Management
• Continuous Improvement

ROLE LEVEL

This position is a senior operational leadership role above the Supervisor level, with accountability for the performance of multiple teams/functions and the overall effectiveness of Patient Access and Authorization operations.

The role is expected to operate beyond day-to-day workflow supervision by setting operational strategy, managing leaders, establishing performance frameworks, driving cross-functional initiatives, resolving complex operational issues, and building scalable processes for healthcare operations.