Director of Prior Authorization & Utilization

EmpiRx Health, LLC.; Montvale (NJ); Hybrid; USD 165,000 - 190,000; Full time

Benefits offered by this job

Paid Time Off

401(k) program

Health Insurance including Dental &amp

Vision coverage

Health Savings Account

Employee Assistance Program

Job summary

EmpiRx Health, LLC. is seeking a Director of Prior Authorization to lead PA pharmacists and technicians, develop policies, and drive utilization management excellence. The role oversees clinical reviews, audits, and compliance while partnering across departments to optimize care and efficiency.

Hybrid work is available with on-site requirements in Montvale, NJ or Orlando, FL. A strong background in PBM operations and analytics will help shape high-quality member outcomes and cost savings.

Qualifications

• Bachelor of Pharmacy degree from an accredited institution.
• 5+ years of prior authorization experience in a PBM or health plan.
• 10+ years of progressive management experience in healthcare or pharmacy operations.
• Proficiency with Microsoft Office Suite (Excel, Word, PowerPoint) and pharmacy management systems.
• Strong ability to lead cross-functional teams and deliver measurable outcomes.

Responsibilities

• Lead and mentor a team of Prior Authorization Pharmacists and Technicians to deliver compliant, high-quality clinical reviews.
• Develop and optimize SOPs and policies for regulatory compliance.
• Monitor and report on performance metrics, turnaround times, and cost-savings impact.
• Collaborate with other departments to align strategies and workflows.
• Support staff training and ongoing professional development.

Skills

Prior Authorization

Team Leadership

Regulatory Compliance

Microsoft Office

Pharmacy Systems

Education

Bachelor of Pharmacy degree

PharmD (preferred)

Tools

DOMO

Salesforce

Power BI

Job description

EmpiRx Health, LLC. is seeking a Director of Prior Authorization to lead PA pharmacists and technicians, develop policies, and drive utilization management excellence. The role oversees clinical reviews, audits, and compliance while partnering across departments to optimize care and efficiency.

Hybrid work is available with on-site requirements in Montvale, NJ or Orlando, FL. A strong background in PBM operations and analytics will help shape high-quality member outcomes and cost savings.