Prior Authorization Manager

JOIN A LEADING HEALTHCARE COMPANY

At Curant Health our vision is to personalize healthcaredriven by choice and defined by value. Our employees bring this vision to life through excellent service personalized care accountability innovation and integrity. We offer competitive pay great benefits and the opportunity to make a meaningful impact every day. We are seeking a Prior Authorization Manager in Smyrna GA or St. Petersburg FL to oversee clinical and operational Prior Authorization (PA) processes and ensure timely access to specialty medications.

POSITION SUMMARY

The Manager Prior Authorization is responsible for the strategic clinical and operational leadership of the Prior Authorization (PA) department. This position oversees prior authorization operations across all lines of business ensuring timely accurate and clinically appropriate review and processing of prior authorization requests appeals and coverage determinations. The Manager serves as the department subject matter expert for all prior authorization and FillNBill.

RESPONSIBILITIES

• Provide leadership direction and oversight for all Prior Authorization operations.
• Directly supervise Prior Authorization Supervisors Prior Authorization Pharmacists/Nurses and Prior Authorization Specialists as applicable.
• Interview hire train coach develop and evaluate department personnel.
• Establish departmental goals productivity standards quality expectations and key performance indicators (KPIs).
• Monitor department workload staffing levels and resource allocation to ensure service level expectations are met.
• Conduct performance evaluations and provide ongoing coaching and professional development for team members.
• Develop and maintain standard operating procedures workflows and training programs related to prior authorization operations.
• Identify operational barriers and implement process improvements to enhance efficiency quality and customer satisfaction.
• Monitor department performance metrics and implement corrective actions when goals are not achieved.
• Lead performance improvement initiatives and monitor outcomes to ensure continuous operational excellence.

QUALIFICATIONS

• Requires a bachelors degree and/or an advanced degree in pharmacy with at least 3 years of experience and is licensed to practice in state.

• Prior experience with performing Prior Authorizations within the pharmacy pharmacy benefit insurance or PBM field. One year of clinical experience is preferred. Familiar with a variety of concepts practices and procedures with a focus on mail-order pharmacy.

• Knowledge of PBM industry formulary management pharmacy claims and managed care principles and practices desired. Exceptional clinical skills and ability to apply sound clinical judgment to various situations is needed.

• 340B knowledge is a plus.

• At least one year of Medical Writing experience preferred.

Required Experience:

Manager