Program Manager - PA Governance & Optimization

Role Description

The Program Manager is responsible for leading enterprise-wide Prior Authorization (PA) governance and optimization efforts, 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.

• Lead large-scale, cross-functional PA governance initiatives, including working with organizational leaders to support enterprise PA priorities.
• Oversee all aspects of PA program planning, management, and execution, ensuring scope, schedule, and budget are managed in alignment with governance standards and enterprise priorities.
• Drive the enterprise-wide PA optimization cycle to plan, with clear decision points, sign-offs, and readiness milestones prior to implementation.
• Ensure ad-hoc PA requests are appropriately triaged, prioritized, and executed without disrupting the core optimization cycle or governance cadence.
• Drive large-scale initiatives by coordinating the work of project managers and business analysts supporting PA workstreams across Operations, Finance, Benefit Operations, Clinical, Analytics, and Technology.
• Create and maintain comprehensive timelines, workplans, and deliverables, ensuring teams follow established project and governance standards.
• Identify implementation risks early and partner with functional leaders to develop mitigation plans ahead of go-live.
• Develop and maintain executive-level dashboards and reporting that provide clear visibility into PA governance decisions, initiative status, risks, and outcomes.
• Prepare concise, decision-ready materials for Program Steering Committees and Executive Leadership, including clear rationale, tradeoffs, and recommendations.
• Partner with PHCO Analytics to monitor post-implementation impact and validate that approved PA code and policy changes are delivering intended outcomes.
• Track utilization or spend anomalies following go-live and ensure insights are surfaced and fed into subsequent PA triage and prioritization cycles.
• Proactively manage program-level risks, dependencies, forecasts, and interdependencies across PA initiatives.
• Serve as the first point of escalation for PA program issues and risks; work directly with project teams to resolve issues and develop mitigation strategies.
• Escalate well-formulated risks and recommendations to leadership with clear articulation of business, clinical, and operational impacts.
• Align stakeholders around data-based prioritization, PA governance standards, and enterprise decision frameworks.
• Create and deliver best-practice guidance and training for indirect reports, peers, and stakeholders to support consistent application of PA governance principles.
• Partner with training teams to develop and review PA-related training materials to support operational readiness and adoption.

Qualifications

• Bachelor’s degree in related field or equivalent experience required.
• Master’s degree preferred.
• 8+ years of Program or Project Management experience required.
• Previous experience as a lead in a functional area, managing cross-functional teams on large scale projects or supervisory experience including hiring, training, assigning work, and managing the performance of staff required.
• Proficiency in MS Office applications and project management tools required.
• Healthcare experience and/or managed care experience preferred.

License/Certification

• Project Management Professional (PMP) or Program Management Professional (PgMP) preferred.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible approach to work with remote, hybrid, field or office work schedules.