Clinical Operations Lead

OperationsRemote (US)Full-time

The application window will remain open until the position is filled. This opportunity will remain posted based on business needs.

About the role

Kestrel builds software for people who do prior authorization every day. To build it well, we need someone on the team who has actually done it. Someone who knows the difference between a pended request and one that's under medical review, who can recite Aetna's fax number from memory, and who understands why "approved" doesn't always mean "done."

As Clinical Operations Lead, you'll be the bridge between our customers and our product team. You'll manage and expand our payer rules library (the knowledge base that tells Kestrel what each payer requires for each procedure), conduct customer onboarding and training calls, and translate messy real-world workflows into clear product requirements.

You don't need to write code. You need to know prior auth inside and out, and care about making it less painful for everyone involved.

Minimum qualifications

3+ years of direct experience with prior authorization workflows in a clinical setting (medical office, billing company, or health plan).
Deep familiarity with major commercial payers (Aetna, UnitedHealthcare, Cigna, Humana, BCBS) and their prior auth requirements.
Experience reading and interpreting clinical documentation (progress notes, operative reports, letters of medical necessity).
Strong organizational skills. You can manage multiple priorities without dropping anything.
Excellent written communication. You'll be writing payer rules, help documentation, and customer-facing content.

Preferred qualifications

Experience as a practice manager, prior auth specialist, or clinical operations manager in a multi-provider practice.
Familiarity with CPT, ICD-10, and HCPCS coding systems.
Experience with EHR systems (Epic, Athena, eClinicalWorks, NextGen, or similar).
Experience with payer portals (Availity, NaviNet, individual payer sites).
Background in training or onboarding clinical staff on new software or workflows.
Experience working with a technology or software company in a clinical advisory or operations role.
Knowledge of CMS regulations, state-level prior auth reform legislation, or the No Surprises Act.

Responsibilities

Own and expand Kestrel's payer rules library. Research payer-specific requirements for procedures, document submission criteria, and maintain accuracy as policies change.
Conduct customer onboarding calls and train practice staff on using Kestrel effectively.
Translate real-world clinical workflows into product requirements and user stories for the engineering team.
Serve as the internal subject matter expert on prior authorization: how it works, what goes wrong, and what "good" looks like.
Review and validate AI-generated clinical extractions for accuracy and clinical appropriateness.
Monitor payer policy changes and update rules accordingly.
Build and maintain help documentation, training materials, and workflow guides.
Provide input on product roadmap priorities based on customer feedback and industry trends.

Compensation

Base salary: $85,000–$125,000 + equity + benefits. Compensation depends on experience and location.

Interested?

We review every application personally and typically respond within a week.

Apply for this role

Kestrel is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other legally protected characteristic. If you need an accommodation during the application process, please let us know at contact@kestrel.to.