Associate Director, Prior Authorization Operations
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Job Description
Associate Director overseeing Prior Authorization Operations for a health technology firm. Responsible for managing operations and ensuring compliance across multiple business lines.
Responsibilities:
- Provide strategic direction and mentorship to PA and Clinical Care leadership to foster a culture of collaboration, professional growth, accountability, and team success.
- Develop, implement, and uphold policies, procedures, and best practices to ensure the prior authorization processes are efficient, compliant, and aligned with organizational goals.
- Define and execute long-term goals to improve workflow and efficiency while maintaining high-quality standards.
- Lead or actively participate in cross-departmental initiatives to enhance overall business operations focusing on optimizing the integration and performance of Prior Authorization processes within the broader organizational structure.
- Ensure that Prior Authorization processes comply with regulatory standards, including URAC, NCQA, and federal and state guidelines, managing risks associated with compliance, regulatory audits, and industry certifications.
- Drive the development of KPIs and performance metrics for the PA department, ensuring that progress is measured against both departmental and organizational goals.
- Generate and present comprehensive reports on PA metrics, operational performance, and process improvements to senior leadership and other stakeholders, providing actionable insights and recommendations.
- Support the Senior Director, Prior Authorization in various strategic projects, initiatives, and operational tasks to continuously improve the PA function.
Requirements:
- Active, unrestricted pharmacist license required
- Doctor of Pharmacy degree required
- 6+ years of experience in Prior Authorization or Utilization Management at a PBM, health plan, or healthcare provider organization
- 4+ years of leadership experience, including direct supervision in a complex, multi-functional environment
- Experience in overseeing multiple lines of business including Commercial, Exchange, and Medicare
- Strong proficiency in data analysis and performance reporting, with the ability to leverage insights for decision-making
- Excellent communication skills, both written and verbal, with significant experience in presenting to executive leadership
- Proficiency in Microsoft Office Suite and familiarity with other advanced data and reporting tools (e.g., Tableau, Power BI, etc.)
- Ability to work effectively in a fast-paced, evolving environment and manage complex, cross-functional teams
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