Description
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: The Program Manager is responsible for leading enterprise‑wide Prior Authorization (PA) governance ensuring disciplined planning, data‑driven prioritization, and effective execution across regulatory, operational, and clinical initiatives. This role partners closely with organizational leaders to drive alignment, manage change, and ensure PA decisions translate into measurable outcomes.
Responsibilities:
Identify opportunities to increase efficiency, improve service levels, and ensure regulatory and PA compliance through enhanced, standardized operations and governance practices.
Develop and execute strategies to realize PA improvement opportunities, ensuring enterprise‑level prioritization, clear decision rights, and appropriate resource alignment.
Manage multiple PA initiatives through the full project lifecycle, including requirements gathering, governance intake, development of project plans and schedules, resource and budget management, execution, deployment, and closure.
Support structured PA governance cycles by ensuring initiatives are evaluated, prioritized, approved, and sequenced in alignment with enterprise standards and readiness criteria.
Utilize corporate and industry‑standard project management and governance tools to manage PA initiatives effectively, including standardized trackers, RAID logs, and decision artifacts.
Maintain detailed and accurate PA program documentation, including action items, risk and issue logs, mitigation plans, and governance decisions, ensuring auditability and traceability.
Maintain accurate and up‑to‑date trackers, RAID logs, and documentation across multiple PA workstreams to support transparency and leadership oversight.
Compile, format, and validate review packets and governance decision materials to ensure consistency, completeness, and decision‑readiness for leadership review.
Coordinate and validate market, clinical, and SME inputs to ensure they are accurately incorporated into final PA governance materials.
Partner with analytics, medical economics, and operations teams to review financial and operational claims data prior to governance review and decision‑making.
Ensure ad‑hoc PA requests are logged, tracked, prioritized, and either executed or formally deferred into subsequent governance cycles.
Maintain a centralized PA documentation repository as the single source of truth for governance artifacts, decisions, and reference materials.
Provide strong leadership and communicate PA program and governance status to stakeholders at all levels, including executive summaries, dashboards, and presentations.
Lead cross‑functional governance and working sessions with Operations, Clinical, Finance, Analytics, Technology, and Compliance partners to meet enterprise objectives and stakeholder expectations.
Negotiate with stakeholders to secure resources, resolve cross‑functional dependencies, and mitigate risks while maintaining alignment to PA governance standards.
Provide functional and operational expertise related to PA programs, requirements, and workflows to support informed decision‑making.
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.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
