Capital Rx · 16 hours ago
Associate Director, Prior Authorization Operations
Denver, CO
Full-time
Onsite
Senior Level, Lead/Staff, Director/Executive
$160K/yr - $170K/yr
6+ years expJudi Health is an enterprise health technology company focused on providing comprehensive health solutions. They are seeking a strategic Associate Director to lead Prior Authorization Operations, ensuring efficiency and compliance across various lines of business while driving collaboration and optimizing operations.
Hospital & Health Care
Responsibilities
Provide strategic direction and mentorship to PA and Clinical Care leadership to foster a culture of collaboration, professional growth, accountability, and team success
Develop, implement, and uphold policies, procedures, and best practices to ensure the prior authorization processes are efficient, compliant, and aligned with organizational goals
Define and execute long-term goals to improve workflow and efficiency while maintaining high-quality standards
Lead or actively participate in cross-departmental initiatives to enhance overall business operations focusing on optimizing the integration and performance of Prior Authorization processes within the broader organizational structure
Ensure that Prior Authorization processes comply with regulatory standards, including URAC, NCQA, and federal and state guidelines, managing risks associated with compliance, regulatory audits, and industry certifications
Drive the development of KPIs and performance metrics for the PA department, ensuring that progress is measured against both departmental and organizational goals
Generate and present comprehensive reports on PA metrics, operational performance, and process improvements to senior leadership and other stakeholders, providing actionable insights and recommendations
Support the Senior Director, Prior Authorization in various strategic projects, initiatives, and operational tasks to continuously improve the PA function
Qualification
Required
Active, unrestricted pharmacist license required
Doctor of Pharmacy degree required
6+ years of experience in Prior Authorization or Utilization Management at a PBM, health plan, or healthcare provider organization
4+ years of leadership experience, including direct supervision in a complex, multi-functional environment
Experience in overseeing multiple lines of business including Commercial, Exchange, and Medicare
Strong proficiency in data analysis and performance reporting, with the ability to leverage insights for decision-making
Excellent communication skills, both written and verbal, with significant experience in presenting to executive leadership
Proficiency in Microsoft Office Suite and familiarity with other advanced data and reporting tools (e.g., Tableau, Power BI, etc.)
Ability to work effectively in a fast-paced, evolving environment and manage complex, cross-functional teams
Company
Capital Rx
Capital Rx is now Judi Health! Navigate to our new page here: https://www.linkedin.com/company/judi-health
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
A. J. Loiacono
CEO
Ryan Kelly
CTO
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