Senior Director, Clinical Prior Authorization — RN Lead

Working Nurse; Los Angeles (CA); On-site; USD 160,000 - 180,000; Full time

Job summary

Working Nurse in West Hills, CA seeks a Sr. Director, Prior Authorization Clinical (RN) to oversee case managers, staff, and compliance. The role drives program development, policy implementation, and workflow improvements in line with CMS and state requirements.

Strong leadership and project management are essential. Applicants should have 5+ years in prior authorization or healthcare operations, with a RN license and a graduation from an accredited nursing program.

Qualifications

• Graduate of an accredited Registered Nursing program with a current, active RN license.
• 5+ years of progressive experience in prior authorization or related healthcare operations.
• Leadership and project management experience to develop high-performing teams and manage priorities.
• Knowledge of CMS, DMHC, DHS, and major California health plan requirements.

Responsibilities

• Staff supervision of prior authorization nurse case managers and support staff.
• Program development and policy implementation to improve workflows.
• Quality assurance, performance evaluation, and compliance monitoring.
• Collaboration with medical directors and clinical leadership on oversight and reporting.

Skills

Staff supervision

Project management

Leadership

Regulatory knowledge

Education

RN licen,se

RN nursing program

Job description

Working Nurse in West Hills, CA seeks a Sr. Director, Prior Authorization Clinical (RN) to oversee case managers, staff, and compliance. The role drives program development, policy implementation, and workflow improvements in line with CMS and state requirements.

Strong leadership and project management are essential. Applicants should have 5+ years in prior authorization or healthcare operations, with a RN license and a graduation from an accredited nursing program.