Job Description

Job Description

Our client, a well-funded and high-growth startup in the Pharmacy Benefits Management space, is seeking a Director of Prior Authorization to join their team as a fully-remote direct hire. This company has 600+ employees and 5,000+ companies as current customers, and has grown 50-100% year-over-year in headcount and revenue for the several years. They've achieved this growth through their mission to lower prices and improve pricing transparency for patients by charging low fixed administrative fees, practicing direct pass-through drug pricing, and de-coupling administrative fees and drug pricing to prevent “spread” markups.

This role will lead the 45-employee clinical review and operations team, which expands as-needed to 60+ seasonally and is projected to grow significantly over the next year. This team includes several frontline/middle managers reporting up to the Director. This person will completely own all authorization review, formulary adherence, and all other clinical utilization programs. This client and patient-facing team and leader has ownership over some of the most critical value/experience-driving functions in the company, and as such will have a great deal of impact on the growth and improvement of the entire organization.

Responsibilities:

• Manage a large team of pharmacists, pharmacy technicians, and quality assurance staff. This team supports the PBM organization's clients by reviewing authorizations for medical appropriateness, formulary adherence, and other clinical controls utilized to drive members to the therapy they need at the lowest cost under their benefit plan.
• Serve as a clinical subject matter expert and leader throughout the organization related to utilization management, and support all clinical pharmacy programs.
• Lead the team to optimize quality, efficiency, and productivity within sound clinical guidelines and company performance targets.
• Lead identification and evaluation of opportunities for improved management of pharmacy benefit drugs through clinical research and analytics that improve medical cost savings and provide clinical quality initiatives
• Forecast and manage high-volume staffing for pharmacist and pharmacy tech positions both temporary and permanent, including but not limited to interview, hire, training, and budgeting

Qualifications:

• Licensed Pharmacist and PharmD. All 50 states will be considered, and no relocation is required.
• 5+ years of experience leading Utilization and Operations teams within a PBM organization
• Experience leading a Prior Authorization / Clinical Review call center team is an absolute must
• Measurable track record of improvement of customer/client experience metrics
• Desire to work in a high-growth startup environment. Work/life is a priority for this company, but the pacing is fast and requires a high-energy self starter.

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