Senior Director, Medicare Advantage Prior Authorization

Arizona Priority Care; Chandler (AZ); On-site; USD 100,000 - 110,000; Full time

Job summary

Arizona Priority Care in Chandler, AZ is seeking an Associate Director of Prior Authorization to lead Medicare Advantage preservice operations and drive performance across the department. You will supervise PA Coordinators, partner with Medical Directors, and ensure CMS NCQA compliance while delivering timely utilization management outcomes.

The role requires 5+ years UM experience and 3+ years of management, with a Bachelor's degree and strong analytical skills.

Qualifications

• Five or more years of Utilization Management experience with Medicare Advantage preservice operations.
• Three or more years of management or supervisory experience in healthcare/managed care.
• Bachelor’s degree in nursing, healthcare administration, business, or related field preferred; RN license preferred but not required.

Responsibilities

• Provide department-wide accountability through supervision and designated clinical leads, ensuring coordinated Prior Authorization operations.
• Translate strategic direction into department priorities, performance expectations, governance standards, and measurable outcomes.
• Establish workforce strategy, capacity models, productivity standards, and resource recommendations; manage attendance and workload distribution.
• Maintain compliance with CMS/NCQA requirements; lead audit readiness and documentation efforts.
• Lead governance of SOPs, workflows, and performance controls; support PA Supervisor with frontline implementation.
• Coordinate semiannual underutilization reviews and contribute to UM Program and committee reporting.

Skills

Leadership

Healthcare management

Utilization Management

CMS/NCQA knowledge

Data analysis

Education

Bachelor’s degree in Nursing / Healthcare Admin

Tools

Microsoft Office

Electronic Health Records (EHR)

Job description

Arizona Priority Care in Chandler, AZ is seeking an Associate Director of Prior Authorization to lead Medicare Advantage preservice operations and drive performance across the department. You will supervise PA Coordinators, partner with Medical Directors, and ensure CMS NCQA compliance while delivering timely utilization management outcomes.

The role requires 5+ years UM experience and 3+ years of management, with a Bachelor's degree and strong analytical skills.