Senior Director, Prior Authorization Governance

Centene Corporation

Senior Director leading enterprise Prior Authorization governance at Centene, a national healthcare organization. Optimizing clinical programs through analytics, automation, compliance, and AI-enabled utilization management.

Posted 8/7/2026full-timeRemote • Montana • 🇺🇸 United StatesSenior💰 $148,000 - $274,200 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Prior Authorization governance, regulatory compliance, and healthcare leadership, with a focus on optimizing processes and enhancing member and provider experiences. Proven ability to lead cross-functional teams and drive data-driven decision-making initiatives.

Highest-signal resume keywords

Prior Authorization ExpertiseUtilization ManagementHealthcare LeadershipProduct DevelopmentRegulatory Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Product PlanningProduct ManagementGovernance StrategyData AnalysisClinical Best PracticesEvidence-Based MedicineDecision-Making FrameworksProgram ExecutionFinancial AnalysisAdministrative Simplification

Soft Skills

LeadershipCollaborationMentoringCommunicationContinuous Improvement

Tools & Technologies

Digital Utilization ManagementAutomation InitiativesAI-Enabled Review Capabilities

Industry Keywords

MedicareMedicaidMarketplaceCommercialDuals PopulationsMental Health ParityComplianceClinical OperationsBehavioral HealthMarket Leadership

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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