Director, Prior Authorization & Appeals — Lead Clinical Ops

EmpiRx Health, LLC.; Orlando (FL); Hybrid; USD 140,000 - 190,000; Full time

Benefits offered by this job

Paid Time Off

401(k) plan

Health Insurance (Dental & Vision)

Health Savings Account

Employee Assistance Program

Job summary

EmpiRx Health in Orlando, FL is seeking a Director of Prior Authorization to lead clinical review and appeals programs, manage a team of pharmacists and technicians, and align utilization management with regulatory and organizational standards.

The Director will develop and optimize workflows, SOPs, and performance measures to drive operational excellence and ensure high-quality care and member satisfaction.

Qualifications

• Bachelor of Pharmacy degree from an accredited institution.
• 5+ years of prior authorization experience within a PBM or health plan.
• 10+ years of progressive management experience in healthcare or pharmacy operations.
• Strong understanding of utilization management, formulary compliance, and appeals processing.
• Advanced proficiency with Microsoft Office Suite (Excel, Word, PowerPoint) and pharmacy management systems.
• Demonstrated ability to lead cross-functional teams, manage complex workflows, and deliver measurable outcomes.

Responsibilities

• Lead and mentor a team of Prior Authorization Pharmacists and Technicians to deliver efficient, compliant, and high-quality clinical review services.
• Conduct performance evaluations, provide developmental feedback, and promote a collaborative, positive team culture.
• Partner with the Vice President of Clinical Services to design and implement strategies that enhance prior authorization effectiveness and scalability.
• Develop, implement, and maintain SOPs and policies that comply with federal, state, and PBM regulations.
• Oversee clinical audits, ensure documentation accuracy, and lead corrective action initiatives as needed.

Skills

Leadership

Cross-functional leadership

Data-driven decisions

Communication

Education

Bachelor of Pharmacy

Tools

Excel

Pharmacy management systems

Job description

EmpiRx Health in Orlando, FL is seeking a Director of Prior Authorization to lead clinical review and appeals programs, manage a team of pharmacists and technicians, and align utilization management with regulatory and organizational standards.

The Director will develop and optimize workflows, SOPs, and performance measures to drive operational excellence and ensure high-quality care and member satisfaction.