Director, Prior Authorization & Clinical Operations

EmpiRx Health; Montvale (NJ); Hybrid; USD 168,000 - 194,000; 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, a leading clinically-driven PBM, seeks a Director of Prior Authorization in Montvale, NJ. Lead a Pharmacist and Technician team, shape SOPs, and drive utilization management excellence to optimize clinical quality and member satisfaction.

You will partner with Clinical Services leadership, develop workflows, monitor performance, and deliver actionable reports using DOMO, Salesforce, and Power BI.

Qualifications

• Bachelor of Pharmacy degree from an accredited institution.
• Active Pharmacist License in good standing.
• 5+ years of prior authorization experience in 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 and pharmacy management systems.
• Demonstrated 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 review services.
• Develop workflows, policies and performance measures to drive efficiency and scalability.
• Monitor PA performance metrics and deliver regular operational reports for leadership.
• Collaborate with cross-functional departments to align PA policies with client implementations.
• Provide clinical guidance and support for client renewals and escalations.

Skills

Prior Authorization

Leadership

Healthcare operations

Education

Bachelor of Pharmacy

PharmD preferred

Tools

Microsoft Office

Pharmacy management systems

DOMO

Salesforce

Job description

EmpiRx Health, a leading clinically-driven PBM, seeks a Director of Prior Authorization in Montvale, NJ. Lead a Pharmacist and Technician team, shape SOPs, and drive utilization management excellence to optimize clinical quality and member satisfaction.

You will partner with Clinical Services leadership, develop workflows, monitor performance, and deliver actionable reports using DOMO, Salesforce, and Power BI.