Associate Director Prior Authorizations Operations Remote

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Associate Director Prior Authorizations Operations Remote (2391105)

Associate Director Prior Authorizations Operations Remote - 2391105

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities.

Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.

The Associate Director, Prior Authorization Operations leads a high-volume pharmacy prior authorization operation, setting direction for a team of leaders and a 100+ clinician and technician workforce. This role owns operational, quality, compliance, and financial performance and drives innovation and process improvement across the end-to-end prior authorization process. Partnering with Clinical Services, Client Services, Compliance, and Technology, this leader connects daily operations to enterprise strategy and helps enable technology solutions that improve the member, provider, and client experience.

This is an opportunity for an aspiring leader ready to make a visible impact and grow toward broader leadership roles at Optum Rx.

You’ll enjoy the flexibility to work remotely
* from anywhere within the U.S. as you take on some tough challenges.

• Lead 5+ direct reports and 100+ indirect pharmacists and technicians; coach, develop, and build a bench of future leaders
• Own end-to-end performance, including turnaround time, quality, productivity, service, and regulatory and contractual guarantees, through real-time inventory and queue management
• Partner with department leadership on volume forecasting, capacity and staffing plans, and budget management
• Drive innovation and continuous process improvement across the prior authorization process, to improve outcomes
• Partner with Technology and Product teams to define requirements, pilot and scale solution; lead change management and adoption across teams
• Serve as the clinical and operational escalation point for complex cases; represent PA Operations with Clinical Services, Client Services, Compliance, and in client meetings
• Maintain audit readiness and compliance with CMS, state, accreditation, and client requirements; monitor quality and safety trends and drive measurable action plans
• Build a culture of accountability, transparency, patient and workforce safety, well-being, and continuous improvement

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

• Doctor of Pharmacy (PharmD) or B.S. Pharmacy with an active, unrestricted pharmacist license, and:
  • 5+ years of pharmacist experience, including 3+ years in prior authorization or utilization management
  • 3+ years of people leadership experience, including leading teams through operational or process change
• In-depth clinical knowledge of disease states, pharmacotherapy, and current treatment guidelines, including specialty and high-cost therapies
• Ability to interpret complex clinical scenarios and apply medical necessity criteria, FDA labeling, and compendia to coverage decisions
• Proven record of delivering…