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Director, Prior Authorization Center

4 months ago

Montvale, United States EmpiRx Health Full time
Who We Are
EmpiRx Health is the leading clinically-driven, customer-first PBM company that puts the pharmacist at the center of its service model to optimize member care while substantially reducing costs for plan sponsors.
What We Do
We place more emphasis on member care than any other PBM by focusing on health outcomes first. Our pharmacists and clinicians are at the center of everything we do―and our population health solution delivers tailored strategies for our clients.
Who We're Looking For
EmpiRx Health is experiencing unprecedented growth, and we're seeking a highly skilled and experienced Director, Prior Authorization Center. As the Director, Prior Authorization Center, you will be a subject matter expert accountable for leading a team of Prior Authorization Pharmacists and Technicians dedicated to the prior authorization and appeals processes. The Director of Prior Authorization Center will create and maintain policies and procedures for utilization management review, optimize staffing workflow, analyze performance trends, generate comprehensive reports on prior authorization/appeal metrics, and lead the recruitment and onboarding process for pharmacist and technicians.
If you are a highly motivated Director, Prior Authorization Center with a strong background in prior authorizations and appeals, and you are passionate about making a meaningful impact in the healthcare industry, we encourage you to apply.
What You'll Do
As a Director, Prior Authorization Center, your role will encompass a wide range of responsibilities:
  • Manage a team to ensure a positive team environment, conduct performance review and provide feedback and opportunities for development.
  • Work with VP of Clinical Operations to develop and implement strategic initiatives to improve the overall effectiveness of the prior authorization services.
  • Develop and implement policies and procedures ensuring compliance with federal, state, and local guidelines.
  • Educate team on relevant changes and developments.
  • Assist with clinical audits, including documentation preparation.
  • Participate in continuous quality improvement efforts to streamline the clinical review process and enhance member care.
  • Monitor and identify performance trends while ensuring timely and cost-effective delivery of care.
  • Ensure that all staff comprehend and comply with professional standards and internal processes and procedures.
  • Generate and deliver prior authorization/appeal reports to both internal and external stakeholders.
  • Monitor quality measures ensuring accuracy to guidelines.
  • Monitor, investigate, and resolve escalated issues related to prior authorization while maintaining a high level of members/provider/clients’ satisfaction.
  • Stay updated with changes in pharmacy practice and industry regulations through continuing education and professional development.
  • Stay informed about EmpiRx Health formulary changes, clinical programs, and internal policies.
  • Support staff training and development.
  • Proficiently utilize pharmacy management software for documentation and communications.
  • Proficiently Utilize EmpiRx Health internal tools for team oversight and monitoring (e.g., DOMO, SalesForce)
  • Proficiently utilize Microsoft Office tools.
  • Utilize external clinical and drug information tools to support clinical reviews and decision-making as well as to stay abreast of current drug pipeline (e.g., IPD, Policy Reporter, UpToDate and MediSpan).
  • Collaborate with cross-functional teams to offer clinical support/ guidance while delivering best-in-class services to our members and clients.
What You Need
  • Bachelor of Pharmacy
  • Active pharmacist license
  • 5+ years of prior authorization experience at health plan and/or PBM.
  • 10+ years of management experience required.
  • Exceptional written/verbal communication skills and interpersonal skills
  • Experienced in Microsoft Office Suite and prescription medication analysis.
  • Ability to work in a fast-paced place with shifting priorities.
  • Ability to work independently and make clinical decisions.
  • Must demonstrate professional practices and adherence to company standards.
  • PharmD preferred
  • MTM certification or other specialty certification preferred
Why Join Us
  • EmpiRx Health is on an extraordinary journey where excellence meets innovation.
  • We are a collaborative team that encourages groundbreaking ideas, values open dialogue, and prioritizes continuous improvement.
  • You will be part of a dynamic team where success is a shared celebration, collaboration fuels progress, and we redefine healthcare together.
  • We offer a generous and competitive benefits package.
  • You will share in the company's success through our discretionary bonus program.
EmpiRx Health is an Equal Opportunity Employer
At EmpiRx Health, we wholeheartedly embrace the power of diversity and the magic of inclusion. The kaleidoscope of unique perspectives, backgrounds, and talents fuels our innovation and sets us apart. We're not just breaking down barriers but actively erasing them to create an environment where opportunity knows no bounds. In unity, we find our strength and invite individuals from all walks of life to join us in our exhilarating journey to shape a brighter, more inclusive future together.
Your career at EmpiRx Health awaits – join us in shaping the future of excellence in healthcare
Careers - EmpiRx Health
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