Director, Prior Authorization

TrueScripts Management Services • Washington, IN

6d

About The Position

The Director, Prior Authorization provides strategic leadership and operational oversight for TrueScripts’ Prior Authorization function. The role oversees team leadership, clinical vendor partnerships, quality management, process improvement, service delivery, and regulatory compliance. As the primary leader of the department, the Director works across Clinical Programs, Member Care, Client Services, Operations, Technology, and Leadership to ensure services are efficient, clinically appropriate, scalable, and aligned with organizational objectives. The Director develops and executes strategies to support member experience, operational effectiveness, client satisfaction, and business growth, using data, technology, and clinical expertise to drive continuous improvement and foster accountability, collaboration, innovation, and service.

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.

Nice To Haves

• 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.

Responsibilities

• Provide strategic direction for the Prior Authorization department and establish goals, metrics, and priorities aligned with organizational objectives.
• Build, develop, and mentor department leaders and team members; lead workforce planning, succession planning, and organizational design.
• Foster service excellence, accountability, innovation, and continuous improvement; manage performance expectations and support professional growth.
• Direct daily Prior Authorization operations to ensure quality, efficiency, and timely service delivery.
• Develop and monitor key performance indicators, service level agreements, operational dashboards, and departmental data.
• Identify trends, risks, and opportunities; lead process improvement and implement scalable operational best practices.
• Ensure consistency and quality across prior authorization activities.
• Own relationships with clinical review vendors and external partners; set performance expectations and monitor outcomes, service levels, and quality measures.
• Collaborate with vendors to improve turnaround times, clinical consistency, and operational effectiveness; evaluate performance and identify process or cost improvements.
• Support implementation of programs, technologies, and clinical initiatives involving external partners.
• Collaborate with Clinical Programs leadership to align prior authorization processes with formulary strategies, utilization management objectives, and client requirements.
• Provide clinical and operational consultation and support implementation of clinical initiatives, products, and services.
• Use operational and clinical data to identify performance improvements and develop reporting and insights for decision-making and strategic planning.
• Monitor industry trends, emerging technologies, and best practices in utilization management and prior authorization.
• Lead initiatives to improve automation, efficiency, quality, and member satisfaction; partner with Technology and Operations to optimize systems and workflows.
• Partner with Client Services, Operations, Member Care, Compliance, Technology, and Clinical teams to achieve organizational goals.
• Participate in client implementations as the subject matter expert for prior authorization services; support client audits, reporting requests, and operational reviews.
• Collaborate on enterprise initiatives affecting clinical operations and member experience.
• Ensure adherence to applicable regulatory, accreditation, and client requirements; maintain policies, procedures, and operational standards.
• Support quality assurance and audits, identify and mitigate operational and compliance risks, and promote quality and consistency.

Benefits

• A range of health insurance options, including medical, dental, and vision.
• Salary and bonus program.
• 401(k) with company match.
• Employee Stock Ownership Plan (ESOP), with annual share allocations to team members.
• Employee Assistance Program.
• Wellness program with financial incentives, chiropractic and massage services, and fitness stipends.
• Dream Manager Program.
• Charitable contributions and volunteer time.
• Cohesive, family-based culture.

What This Job Offers

• Job Type: Full-time
• Career Level: Director