Senior Director, Prior Authorization Governance

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🔥 0 minutes ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $148k - $274.2k / year

⏰ Full Time

🟠 Senior

🎲 Risk

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Lead enterprise Prior Authorization governance strategy across Medicare, Medicaid, Marketplace, Commercial, and Duals populations • Oversee governance structures, decision-making frameworks, and approval processes for Prior Authorization requirement changes • Direct semi-annual and annual enterprise reviews of PA rules, code lists, and authorization requirements • Ensure PA criteria align with evidence-based medicine, clinical best practices, and organizational goals • Partner with Compliance, Legal, Medical Affairs, and Market Leadership to assess regulatory impacts and mitigation strategies • Support Mental Health Parity and other regulatory reviews requiring PA governance oversight • Analyze emerging trends and identify opportunities to improve effectiveness and administrative simplification • Monitor impacts of PA policy changes and recommend corrective actions • Sponsor data-driven decision-making and continuous improvement initiatives • Lead collaboration across Clinical Operations, Behavioral Health, Medical Affairs, Technology, Compliance, Finance, Analytics, Pharmacy, Market Operations, and Provider teams • Develop and mentor leaders responsible for governance, optimization, and program execution • Lead enterprise PA optimization initiatives to reduce administrative burden and improve member and provider experience • Support digital utilization management strategies, automation initiatives, and AI-enabled review capabilities

🎯 Requirements

• Bachelor’s degree in a related field or equivalent experience • 7+ years of product development, product management, or related experience • Experience with product planning, development, execution, and product financials • Experience across different market segments and product types • 10+ years of progressive healthcare leadership experience • Prior Authorization and Utilization Management expertise

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation