Director, Prior Authorization

Description

TrueScripts Management Services is a pharmacist-founded, fully transparent Prescription Benefit Manager that has been revolutionizing the PBM industry since 2014. Our mission is to build lasting relationships by providing prescription benefit expertise at a personal and customized level to ensure optimum value at the lowest possible cost. We are committed to lowering prescription drug spending, achieving clinically effective outcomes, and always delivering Amazing Care.Did we mention Amazing Care? Good! Because this is so much more than just our tagline. It is the foundation upon which our business was built. We believe that Amazing Care starts from within, and our culture is reflective of this philosophy. Our team members enjoy:

• A wide range of health insurance options including medical, dental and vision
• A strong salary and bonus program
• A robust 401k and company match
• Truescripts is transitioning to an ESOP, a team member owned company! Each year team members are allocated shares of stock through our ESOP, a Qualified Retirement plan!
• Employee Assistance Program
• A wellness program including financial incentives, chiropractic and massage services, and fitness stipends
• Dream Manager Program (yes, it’s a real thing!)
• A cohesive, family-based culture
• Charitable contributions and volunteer time

Ok, enough about us. Here’s what we need from you: A future team members' values need to align with TrueScripts' core values of Integrity, Respect, Innovation, and Service. This match in value systems is critical for our team's chemistry and continued success. Our culture is positive, and our people possess a ‘can do, proactive attitude. Honesty and transparency are the foundation that we build upon. What sets us apart from our competitors is the programs that we bring, the education that we provide, and the utmost respect for clients and their members to assist them when and where needed.

Position Overview:
The Director, Prior Authorization is responsible for the strategic leadership, performance, and operational excellence of TrueScripts' Prior Authorization function. This role oversees all aspects of prior authorization operations, including team leadership, clinical vendor partnerships, quality management, process improvement, service delivery, and regulatory compliance. The Director serves as the primary leader of the Prior Authorization department and works collaboratively across Clinical Programs, Member Care, Client Services, Operations, Technology, and Leadership to ensure prior authorization services are efficient, clinically appropriate, scalable, and aligned with organizational objectives. This role is responsible for developing and executing departmental strategies that support exceptional member experiences, operational effectiveness, client satisfaction, and business growth. The Director will leverage data, technology, and clinical expertise to drive continuous improvement while fostering a culture of accountability, collaboration, innovation, and service.

Role and Responsibilities

Department Leadership 

• 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 within the department 
• Lead workforce planning, succession planning, and organizational design efforts for the Prior Authorization function 
• Foster a culture centered on service excellence, accountability, innovation, and continuous improvement 
• Manage performance expectations and support professional growth across the department 

Operational Excellence 

• Direct daily Prior Authorization operations to ensure quality, efficiency, and timely service delivery 
• Develop and monitor key performance indicators, service level agreements, and operational dashboards 
• Identify trends, risks, and opportunities through ongoing analysis of departmental data 
• Lead process improvement initiatives that enhance efficiency, quality, and member experience 
• Evaluate workflows and implement operational best practices to support scalability and growth 
• Ensure consistency and quality across all prior authorization activities 

Clinical Vendor & Partner Management 

• Serve as the primary relationship owner for clinical review vendors and other external partners 
• Establish performance expectations and monitor vendor outcomes, service levels, and quality measures 
• Collaborate with vendors to improve turnaround times, clinical consistency, and operational effectiveness 
• Evaluate vendor performance and identify opportunities for process enhancement or cost savings 
• Support implementation of new programs, technologies, and clinical initiatives involving external partners 

Clinical Program Support 

• Collaborate with Clinical Programs leadership to ensure prior authorization processes align with formulary strategies, utilization management objectives, and client requirements 
• Provide clinical and operational consultation related to prior authorization programs 
• Support implementation of new clinical initiatives, products, and services 
• Ensure alignment between prior authorization operations and evolving client needs 

Data Analytics & Continuous Improvement 

• Utilize operational and clinical data to identify opportunities for performance improvements 
• Develop reporting and insights to support decision-making and strategic planning 
• Monitor industry trends, emerging technologies, and best practices related to utilization management and prior authorization 
• Lead initiatives that improve automation, efficiency, quality, and member satisfaction 
• Partner with Technology and Operations teams to optimize systems and workflows 

Cross-Functional Collaboration 

• Partner with Client Services, Operations, Member Care, Compliance, Technology, and Clinical teams to achieve organizational goals 
• Participate in client implementation activities as subject matter expert for prior authorization services 
• Support client audits, reporting requests, and operational reviews 
• Collaborate on enterprise initiatives impacting clinical operations and member experience 

Compliance & Quality 

• Ensure department adherence to applicable regulatory, accreditation, and client requirements 
• Maintain policies, procedures, and operational standards related to prior authorization activities 
• Support quality assurance and audit activities 
• Identify and mitigate operational and compliance risks within the department 
• Promote a culture of quality, consistency, and continuous improvement 

Requirements

Required 

• 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 

Preferred 

• PBM experience 
• Prior authorization leadership experience 
• Utilization management experience 
• Multi-state operations experience 
• Experience managing external clinical vendors 
• Experience leading large-scale process improvement initiatives 
• Lean, Six Sigma, or related process improvement experience