[Hiring] Manager, Clinical Operations @Rosarium Health

Role Description

We are hiring a Manager, Clinical Operations to:

• Manage the Prior Authorization process with Payers
• Oversee the end-to-end process for prior authorization submission, timely approval, and respond to denials and appeals
• Work with operations staff for timely completion of internal documentation and processes that impact submission of prior authorizations
• Identify process improvement opportunities to streamline process for approval and mitigate denials
• Onboard and support the clinician network
• Provide onboarding for all new network clinicians, including initial training on Rosarium processes, expectations, and assessments
• Provide ongoing support to clinicians
• Identify opportunity for improvement for current training documents, development of educational programs, and ideas to enhance the knowledge/skills for our clinicians
• Oversee clinician performance including documentation on assessments, compliance with Rosarium Health requirements, and provide additional training and support as needed
• Identify opportunities for improvement in structure, ability to obtain proper information and/or other enhancements to ensure quality and efficiency of the clinical assessment
• Collaborate with product and tech to enhance the ability for data collection and reporting from assessments

You will work directly with the Chief Clinical Officer and collaborate with Product and Engineering to improve the systems used by clinicians and operations teams. This role is designed for someone who wants to grow into a senior leadership position in clinical operations.

Qualifications

• 4–8 years of experience in homecare, health plan, clinical operations, utilization management
• Knowledge and/or experience with Payer Prior Authorization process
• Strong clinical background, preferably in the home setting
• Experience in training clinicians, developing training materials, managing clinician performance
• Ability to identify areas for operational efficiencies and improvement
• Comfortable working across functional areas, including Product and Engineering teams

Requirements

• Preferred Clinical Background: Occupational Therapist (OT), Physical Therapist (PT), Registered Nurse (RN)
• Preferred Experience:
  • Experience in evaluation of home environment for safety and accessibility gaps
  • Understanding of clinical documentation requirements to support medical necessity for home modifications
  • Knowledge of Managed Medicaid, Medicare Advantage, D-SNP
  • Experience at a venture-backed healthcare or digital health company

Benefits

• Base salary: $95,000–$110,000
• Meaningful equity ownership
• Medical, dental, and vision coverage
• Flexible PTO
• Remote-first culture
• Opportunity to grow into a senior leadership role