Senior Director, Prior Authorization Governance

• Lead enterprise PA governance strategy across Medicare, Medicaid, Marketplace, Commercial, and Duals populations.
• Oversee governance structures, decision-making frameworks, and approval processes for PA 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 as needed.
• 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 activities.
• Lead enterprise PA optimization initiatives focused on reducing administrative burden and improving member and provider experience.
• Support digital utilization management strategies, automation initiatives, and AI-enabled review capabilities.

Education/Experience: Bachelor’s degree in related field or equivalent experience. 7+ years of product development/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.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Pay Range: $148,000.00 - $274,200.00 per year