Director, Part C & Authorizations

Habitat Health

United States, United States
On-site
Claims processing
Utilization management
Encounter data processing
Habitat Health provides personalized, coordinated clinical and social care as well as health plan coverage through the Program of All-Inclusive Care for the Elderly (“PACE”)

Job Summary

  • Habitat Health provides personalized, coordinated clinical and social care as well as health plan coverage through the Program of All-Inclusive Care for the Elderly (“PACE”).
  • This role will build scalable processes to ensure the accuracy, timeliness, and quality of service authorizations, claims adjudication, and encounter data by conducting retrospective reviews, maintaining robust reporting, and overseeing daily operational performance.
  • The role's core accountabilities include setting the vision, operating standards, and governance framework for Part C authorizations, claims processing, and encounter data operations, ensuring regulatory compliance and operational consistency.

Matching Summary

Habitat Health provides personalized, coordinated clinical and social care as well as health plan coverage through the Program of All-Inclusive Care for the Elderly (“PACE”).

Skills & Requirements

Must-have

  • claims processing
  • utilization management
  • encounter data processing
  • operational oversight
  • regulatory compliance

Nice-to-have

  • detail oriented
  • process driven
  • scalable processes
  • continuous process improvement

Key Requirements

  • deep knowledge of claims processing
  • deep knowledge of utilization management
  • experience with Part C authorizations
  • experience with encounter data operations
  • experience with TPA oversight

Work Rights

Not specified

Tailored Resume

Cover Letter