Senior Director, Prior Authorization Governance

Location: Remote-MO, United States

Salary: $134,600.00–$249,000.00 per year

Company

hirify.global is a diversified national healthcare organization serving 28 million members.

What you will do

• Lead enterprise-wide prior authorization governance across Medicare, Medicaid, Marketplace, Commercial, and Duals populations.
• Oversee governance structures, decision-making frameworks, approval processes, and recurring reviews of PA rules, code lists, and authorization requirements.
• Ensure PA criteria align with evidence-based medicine, clinical best practices, regulatory requirements, and organizational objectives.
• Partner with Clinical Operations, Medical Affairs, Compliance, Legal, Technology, Analytics, Finance, Pharmacy, Provider Network, and market leadership.
• Analyze trends, monitor policy impacts, recommend corrective actions, and sponsor data-driven continuous improvement.
• Lead PA optimization, digital utilization management, automation, and AI-enabled review initiatives while reducing administrative burden.

Requirements

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

Culture & Benefits

• Full-time employment with a flexible remote, hybrid, field, or office work approach.
• Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, and holidays.
• Pay is adjusted based on skills, experience, education, job-related factors, and employment status.
• Additional compensation incentives may be available subject to program eligibility.
• hirify.global is committed to equal employment opportunity and workplace diversity.