Senior Director, Prior Authorization Governance

Centene
Missouri
Workplace: RemoteFull timeUSD 148,000 - 274,200 annuallyFunction: Executive & General ManagementExperience: 7+ yearsEducation: bachelorsSkills: ["Leadership","Data-driven decision-making","Cross-functional collaboration","Strategic planning","Continuous improvement"]

Lead enterprise-wide Prior Authorization governance strategy and optimization across Medicare, Medicaid, Marketplace, Commercial, and Duals. Oversee governance structures, approval processes, and semi-annual/annual reviews of PA rules, code lists, and authorization requirements. Partner with Clinical Operations, Medical Affairs, Compliance, Technology, Analytics, Finance, Pharmacy, Provider teams, and Market leadership to ensure PA criteria are evidence-based, clinically appropriate, operationally efficient, and compliant—using data analytics and AI-enabled review capabilities to reduce administrative burden.

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FursaFursa
Centene
Centene
3 days ago

Senior Director, Prior Authorization Governance

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Last checked: 18 hours agoStatus: Live

Job Summary

Lead enterprise-wide Prior Authorization governance strategy and optimization across Medicare, Medicaid, Marketplace, Commercial, and Duals. Oversee governance structures, approval processes, and semi-annual/annual reviews of PA rules, code lists, and authorization requirements. Partner with Clinical Operations, Medical Affairs, Compliance, Technology, Analytics, Finance, Pharmacy, Provider teams, and Market leadership to ensure PA criteria are evidence-based, clinically appropriate, operationally efficient, and compliant—using data analytics and AI-enabled review capabilities to reduce administrative burden.
Location: Missouri
Workplace: Remote
Employment Type: Full time
Job Function: Executive & General Management
Seniority: Director level

Key Responsibilities

  • •Lead enterprise Prior Authorization governance strategy across Medicare, Medicaid, Marketplace, Commercial, and Duals populations.
  • •Oversee governance structures, decision-making frameworks, and approval processes for PA requirement changes.
  • •Conduct semi-annual and annual enterprise reviews of PA rules, code lists, and authorization requirements.
  • •Partner with Compliance, Legal, Medical Affairs, and Market leadership to assess regulatory impacts and mitigation strategies.
  • •Analyze emerging trends and lead PA optimization initiatives to reduce administrative burden and improve member and provider experience.

Pay and Benefits

Salary: USD 148,000 - 274,200 annually
Perks:Health Insurance401kEquityLearning BudgetPaid LeaveRemote Work

Key Requirements

  • •Bachelor’s degree in a related field or equivalent experience.
  • •7+ years of product development/management or related experience, including product planning, execution, and product financials.
  • •Experience across multiple market segments and product types.
  • •10+ years of progressive healthcare leadership experience.
  • •Prior Authorization/Utilization Management expertise to drive clinically appropriate, compliant governance outcomes.
Experience:7+ yearsHealthcareUtilization managementPrior authorization
Education:Bachelor's
Skills:LeadershipData-driven decision-makingCross-functional collaborationStrategic planningContinuous improvement
Tech Stack:AIData analyticsAutomation

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn