Director, Prior Authorization

🔥 58 minutes ago

☕ Washington – Remote

☕ Washington – Remote

⏰ Full Time

🔴 Lead

👔 Director

👻 Ghost score 10%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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TrueScripts Management Services

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2014

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

TrueScripts Management Services is dedicated to providing exceptional prescription benefit management services. With a focus on delivering maximum savings and amazing care, TrueScripts works closely with members, clients, brokers, and prescribers to offer personalized and customized solutions. The company prides itself on transparency and efficiency, featuring a 24-48 hour turnaround time for prior authorization requests and a commitment to customer service, ensuring that real people are available to assist over 99% of the time.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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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