Director, Prior Authorization

🕒 6 dias atrás

☕ Washington – Remoto

☕ Washington – Remote

⏰ Tempo Integral

🔴 Especialista

👔 Diretor

👻 Score fantasma 10%

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• Aberta há 6 dias.
• As vagas desta empresa costumam ser preenchidas em 26 dias.
• Sem salário divulgado.

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TrueScripts Management Services

SiteLinkedInTodas as Vagas

51 - 200 funcionários

Fundada em 2014

🏥 Saúde

💼 Consultoria

⚕️ Seguro de Saúde

Healthcare • Consulting • Healthcare Insurance

A TrueScripts Management Services dedica-se a fornecer serviços excepcionais de gestão de benefícios de prescrição. Com foco em oferecer economia máxima e atendimento incrível, a TrueScripts trabalha em estreita colaboração com membros, clientes, corretores e prescritores para oferecer soluções personalizadas e sob medida. A empresa se orgulha de sua transparência e eficiência, oferecendo um tempo de resposta de 24 a 48 horas para solicitações de autorização prévia e um compromisso com o atendimento ao cliente, garantindo que pessoas reais estejam disponíveis para ajudar em mais de 99% das vezes.

Descrição

• Provide overall leadership and strategic direction for the Prior Authorization department • Establish departmental goals, metrics, and priorities aligned with organizational objectives • Build, develop, and mentor leaders and team members • Lead workforce planning, succession planning, and organizational design efforts • Foster service excellence, accountability, innovation, and continuous improvement • Direct daily Prior Authorization operations for quality, efficiency, and timely service delivery • Develop and monitor KPIs, service level agreements, and operational dashboards • Analyze departmental data to identify trends, risks, and opportunities • Lead process improvement initiatives and implement operational best practices • Ensure consistency and quality across prior authorization activities • Manage relationships and performance expectations for clinical review vendors and external partners • Collaborate with vendors to improve turnaround times, clinical consistency, and operational effectiveness • Support implementation of programs, technologies, and clinical initiatives involving external partners • Align prior authorization processes with formulary strategies, utilization management objectives, and client requirements • Provide clinical and operational consultation on prior authorization programs • Use operational and clinical data to drive performance improvements and strategic planning • Monitor industry trends, emerging technologies, and utilization management best practices • Lead automation, efficiency, quality, and member satisfaction initiatives • Partner with Technology and Operations teams to optimize systems and workflows • Collaborate with Client Services, Operations, Member Care, Compliance, Technology, and Clinical teams • Participate in client implementations as the prior authorization subject matter expert • Support client audits, reporting requests, and operational reviews • Ensure adherence to regulatory, accreditation, and client requirements • Maintain prior authorization policies, procedures, and operational standards • Support quality assurance and audit activities • Identify and mitigate operational and compliance risks

🎯 Requisitos

• Bachelor of Science in Pharmacy (BSPharm) or Doctor of Pharmacy (PharmD) • Active pharmacist license in good standing • Minimum of 7-10 years of pharmacy, clinical operations, prior authorization, utilization management, or related healthcare experience • Minimum of 3-5 years of leadership experience with responsibility for team performance and operational outcomes • Demonstrated experience leading people, processes, and complex operational initiatives • Strong analytical and problem-solving skills • Experience using data to drive operational and business decisions • Excellent communication, presentation, and relationship management skills • PBM experience preferred • Prior authorization leadership experience preferred • Utilization management experience preferred • Multi-state operations experience preferred • Experience managing external clinical vendors preferred • Experience leading large-scale process improvement initiatives preferred • Lean, Six Sigma, or related process improvement experience preferred

🏖️ Benefícios

• A wide range of health insurance options including medical, dental and vision • A strong salary and bonus program • A robust 401k and company match • Employee Stock Ownership Plan (ESOP) with annual stock allocations • Employee Assistance Program • Wellness program including financial incentives, chiropractic and massage services, and fitness stipends • Dream Manager Program • A cohesive, family-based culture • Charitable contributions and volunteer time

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