Program Manager, Principal (Prior Authorization)

Your Role

The Enterprise Prior Authorization Accountability Program Manager will serve as the Accountable Business Driver for all enterprise-wide prior authorization initiatives. This role ensures compliance with federal and state mandates, AHIP (America's Health Insurance Plans) commitments, and organizational governance standards while driving operational excellence and cross-functional alignment. The position reports to the Vice President, Medical Care Solutions and partners closely with Healthcare Quality and Affordability leadership, clinical teams, and technology stakeholders. In this role you will help provide strategic direction for prior authorization and drive organizational alignment balancing affordability with industry requirements across a multi-year effort and implementation.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

• Requires a college degree or equivalent experience and minimum 10 years of prior relevant experience
• Master's Degree in a healthcare field preferred
• Requires strong knowledge of federal and state regulations. Knowledge of prior authorization preferred.
• Knowledge of Blue Shield of CA or similar health care organization structure.
• Technically proficient having broad background in problem solving tools.
• Knowledge in developing and implementing company-wide, organizational development or process improvement programs.