Prior Authorization Associate Director

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing whole-person care to Senior and Medicaid populations, through advanced value-based models. Our provider network is comprised of more than 6,000 health care providers, including primary and specialty care physicians, hospitals and ancillary providers. We have operated in the Arizona market for more than 14 years, based in Chandler, Arizona, and are an affiliate of Heritage Provider Network. As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing cost.

The Associate Director of Prior Authorization provides department-wide leadership and accountability for Medicare Advantage utilization management preservice functions. Reporting to and developing under the guidance of the Director of Clinical Services Operations, this position leads through the PA Supervisor and designated clinical leads. The role owns regulatory governance, aggregate performance, audit readiness, workforce strategy, executive reporting, and cross-functional improvement, while frontline workflow execution and direct supervision of PA Coordinators remain with the PA Supervisor.

A. POSITION DUTIES & RESPONSIBILITIES

Department Leadership & Operations

• Provide department-wide accountability through the PA Supervisor and designated clinical leads, ensuring coordinated clinical and non-clinical Prior Authorization operations.
• Translate the Director’s strategic direction into department priorities, performance expectations, governance standards, and measurable outcomes.
• Establish workforce strategy, capacity models, productivity standards, and resource recommendations; hold frontline leaders accountable for scheduling, workload distribution, attendance, and productivity.
• Resolve systemic, high-risk, or cross-functional issues that cannot be resolved at the Supervisor level; elevate clinical, regulatory, or organizational risks to the Director as appropriate.
• Lead department leadership meetings and mentor the PA Supervisor and clinical leads; set expectations for huddles, 1:1s, onboarding, coaching, and training carried out by frontline leadership.
• Evaluate and develop direct reports, strengthen leadership capability, and support succession planning; ensure frontline performance management is completed consistently by the PA Supervisor.

Compliance, Quality & Audit Readiness

• Ensure Medicare Advantage preservice operations comply with CMS, NCQA, contracted health plan, and applicable state and federal requirements.
• Own aggregate turnaround-time, notification, documentation, and compliance performance; review trend reporting and hold the PA Supervisor and clinical leads accountable for timely operational correction.
• Establish the department’s quality-audit framework, sampling expectations, and performance targets; validate trends and oversee corrective action while routine staff audits and coaching are completed by the PA Supervisor.
• Maintain continuous audit readiness and lead preparation of PA documentation, reports, and supporting evidence for CMS, NCQA, health plan, and internal audits in partnership with the Director.
• Identify compliance gaps, complete root-cause analysis, develop, implement, and monitor corrective action plans through sustained resolution.

Process Improvement, Reporting & Programs

• Evaluate aggregate authorization volumes, denials, pends, delays, productivity, quality results, and workload trends to identify enterprise risks, capacity needs, and improvement priorities.
• Ensure timely, complete, and accurate internal and external UM reports, audit submissions, dashboards, and management updates, including barriers and planned interventions.
• Own governance and approval of standard operating procedures, workflows, job aids, and performance controls; delegate detailed maintenance, training, and frontline implementation to the PA Supervisor.
• Coordinate semiannual underutilization review activities and contribute to the UM Program, UM Work Plan, annual evaluations, and committee reporting.
• Lead delegated PA programs, vendor initiatives, system enhancements, and operational projects, including transition-of-care and continuity-of-care activities related to contract or capitation changes.

Stakeholder, Provider & Committee Engagement

• Serve as the senior escalation liaison with Medical Directors, health plans, providers, internal departments, vendors, and other partners for systemic, high-risk, or unresolved PA matters.
• Participate in UM and Quality Improvement Committees, Joint Operating Committees, provider and health plan meetings as assigned; prepare accurate supporting materials and follow-up actions.
• Lead resolution of escalated or systemic member and provider service issues, using trend findings to direct sustainable department improvements.
• Maintain working knowledge of contracted products and benefit structures relevant to PA operations, with particular expertise in Medicare Advantage.
• Represent the department professionally and communicate operational risks, performance, and recommendations clearly to leadership and stakeholders.

B. EDUCATION, TRAINING & EXPERIENCE

• Five or more years of progressively responsible Utilization Management experience, including comprehensive knowledge of Medicare Advantage prior authorization and preservice operations.
• Three or more years of management or supervisory experience in healthcare, managed care, delegated entity, or payer environment.
• Bachelor’s degree in nursing, healthcare administration, business, or a related field preferred; equivalent relevant experience may be considered.
• Graduation from an accredited Registered Nurse program and a current, unrestricted Arizona RN license preferred but not required.
• Strong knowledge of CMS Medicare Advantage requirements, NCQA Utilization Management standards, managed care regulations, health plan requirements, and audit expectations.
• Demonstrated ability to lead clinical and non-clinical teams, manage competing priorities, and maintain performance in a high-volume environment.
• Strong analytical, written, verbal, interpersonal, problem-solving, and change-management skills.
• Proficiency with Microsoft Office applications and experience with electronic health record, utilization management, prior authorization, and reporting systems.

*This role requires 60 days FT in office presence, hybrid options will be available after the 60-day period.*

Compensation range: The salary range for this position is: $100,000-$110, 000 Annually