10 prior authorization operations experts

Experience: Nurse Executive, Director of Medical Management · Blue Cross Blue Shield

Nurse Executive, Director of Medical Management at Blue Cross Blue Shield since 2022, leading the Medical Management department. The profile says the department includes prior authorization, acute and post-acute concurrent review teams, auditing and reporting teams, behavioral health and medical claims review teams.

Experience: National Operations Director Prior Authorization Utilization Management · Cigna Healthcare

National Operations Director Prior Authorization Utilization Management at Cigna Healthcare from 2018 to 2023, and National Operations Director Pre Post Utilization Management at The Cigna Group since 2022. The profile also lists national clinical precertification director roles at Cigna and Director Health Management at Great Western Insurance Company (2004–2008).

Experience: System Director Patient Access · Carle Health

System Director Patient Access at Carle Health since 2023, serving the Champaign-Urbana, Richland County and Hoopeston-Danville, Illinois markets; the profile says she leads hospital-based and clinic-based teams, including front-line and prior authorization staff. She earlier worked at Carle Health as Supervisor (2015–2022) and Manager Patient Access (2022–2023).

Experience: Director of Prior Authorization · Blue Cross Blue Shield of Arizona

Former Director of Prior Authorization at Blue Cross Blue Shield of Arizona (2022–2023). Before that she was Regional Director at UnitedHealth Group (2017–2019) and Regional Director of UM at Molina Healthcare (2013–2017); the profile describes more than 30 years as a nurse, including 13 years in utilization management.

Experience: Director Of Operations - Patient Access - Prior Authorizations - Specialty Pharmacy · Evernorth Health Services

Director Of Operations - Patient Access - Prior Authorizations - Specialty Pharmacy at Evernorth Health Services since 2021, a role the profile places at Accredo, an Express Scripts company, and describes as managing authorizations. Before that she held specialty pharmacy operations roles at Cigna Healthcare, including Specialty Pharmacy Operations Senior Manager (2018–2019).

Experience: Director of Prior Authorization and Utilization Management · MedImpact Healthcare Systems, Inc.

Director of Prior Authorization and Utilization Management at MedImpact Healthcare Systems, Inc. since 2018. The profile describes a Pharm.D. with 20-plus years in health plan and PBM organizations who influences a team of over 400 pharmacists, technicians and ancillary staff. Before MedImpact she was Director of Clinical Pharmacy Operations at Health Net (2005–2018).

Experience: Director, PA and Utilization Management · Navitus Health Solutions

Director, PA and Utilization Management at Navitus Health Solutions from 2023 to 2025, with a profile headline of Sr. Director, Utilization Management at Navitus. At Navitus she was earlier Manager, Prior Authorization Operations (2015–2017), Sr. Manager Prior Authorization Operations (2017–2019) and Associate Director Prior Authorization (2019–2023).

Experience: Director of Medical Management for Commercial and Medicare Advantage Prior Authorization programs · Blue Cross Blue Shield of Michigan

Director of Medical Management for Commercial and Medicare Advantage Prior Authorization programs at Blue Cross Blue Shield of Michigan, a role listed from 2004; the profile says the role is responsible for BCBSM's Utilization Management. She also served there as Director of Wellness, Care Management and Health Promotion Programs (2011–2013).

Experience: Network Director · St. Luke's University Health Network

Network Director at St. Luke's University Health Network since 2022, where the profile says she leads approximately 180 employees across prior authorization, financial navigation, insurance verification and denial prevention, partnering with physician leaders and provider service lines. Before that she was a Supervisor and Service Manager at Lehigh Valley Health Network (2014–2018).

Experience: Director Utilization Management-Prior Authorizations · UnitedHealth Care Military & Vetrans

Former Director Utilization Management-Prior Authorizations at UnitedHealth Care Military & Vetrans (2015–2018), followed by Senior Director Utilization Management at Centene Healthcare (2018–2023). Earlier roles include Director Referral Management and PQC at TriWest Healthcare Alliance (2009–2013) and Manager, Medical Management Administration at Blue Cross Blue Shield of Arizona (2013–2015).