Jobs in the United States

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Added 1 min ago
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Relief Mental Health Crisis Specialist - QMHP
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Austin, TX
- $24.18 to $25.39 USD / hour
Best practices for treatment of complex behavioral health, developmental and/or co-occurring disorders
Added 2 mins ago
J
Technical Program Manager
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Remote, United States
- $191,226 to $219,746 USD / year
This position is listed on behalf of a partner company, which manages all applications and next steps. Our partner is looking for a Technical Program Manager based in the United States.
Added 2 mins ago
Client Care Manager- Licensed Customs Broker
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…applications and next steps. Our partner is looking for a Client Care Manager – Licensed Customs Broker based in the United…
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Administrative Assistant (Substitute) (SC - ISTI)
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Mission Viejo, CA
- $30.01 USD / hour
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Added 3 mins ago
Senior Deployment Manager - Datacenter and Network Infrastructure
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Remote, United States
…deployment, network engineering, datacenter operations, or technical program management. 5+ years of engineering leadership managing teams or complex technical…
Added 5 mins ago
Delivery Readiness & Enablement Manager
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Added 5 mins ago
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Added 9 mins ago
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TrueScripts Management Services

Director, Prior Authorization

Washington, IN, United States

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Job details

Posting language: English
Posted: Nov 4, 2026

Original job description

Description TrueScripts Management Services is a pharmacist-founded, fully transparent Prescription Benefit Manager that has been revolutionizing the PBM industry since 2014. Our mission is to build lasting relationships by providing prescription benefit expertise at a personal and customized level to ensure optimum value at the lowest possible cost. We are committed to lowering prescription drug spending, achieving clinically effective outcomes, and always delivering Amazing Care.Did we mention Amazing Care? Good! Because this is so much more than just our tagline. It is the foundation upon which our business was built. We believe that Amazing Care starts from within, and our culture is reflective of this philosophy. Our team members enjoy:

A wide range of health insurance options including medical, dental and vision
A strong salary and bonus program
A robust 401k and company match
Truescripts is transitioning to an ESOP, a team member owned company! Each year team members are allocated shares of stock through our ESOP, a Qualified Retirement plan!
Employee Assistance Program
A wellness program including financial incentives, chiropractic and massage services, and fitness stipends
Dream Manager Program (yes, it’s a real thing!)
A cohesive, family-based culture
Charitable contributions and volunteer time

Ok, enough about us. Here’s what we need from you: A future team members' values need to align with TrueScripts' core values of Integrity, Respect, Innovation, and Service. This match in value systems is critical for our team's chemistry and continued success. Our culture is positive, and our people possess a ‘can do, proactive attitude. Honesty and transparency are the foundation that we build upon. What sets us apart from our competitors is the programs that we bring, the education that we provide, and the utmost respect for clients and their members to assist them when and where needed.

Position Overview:

The Director, Prior Authorization is responsible for the strategic leadership, performance, and operational excellence of TrueScripts' Prior Authorization function. This role oversees all aspects of prior authorization operations, including team leadership, clinical vendor partnerships, quality management, process improvement, service delivery, and regulatory compliance. The Director serves as the primary leader of the Prior Authorization department and works collaboratively across Clinical Programs, Member Care, Client Services, Operations, Technology, and Leadership to ensure prior authorization services are efficient, clinically appropriate, scalable, and aligned with organizational objectives. This role is responsible for developing and executing departmental strategies that support exceptional member experiences, operational effectiveness, client satisfaction, and business growth. The Director will leverage data, technology, and clinical expertise to drive continuous improvement while fostering a culture of accountability, collaboration, innovation, and service.

Role and Responsibilities

Department Leadership

Provide overall leadership and strategic direction for the Prior Authorization department
Establish departmental goals, metrics, and priorities aligned with organizational objectives
Build, develop, and mentor leaders and team members within the department
Lead workforce planning, succession planning, and organizational design efforts for the Prior Authorization function
Foster a culture centered on service excellence, accountability, innovation, and continuous improvement
Manage performance expectations and support professional growth across the department

Operational Excellence

Direct daily Prior Authorization operations to ensure quality, efficiency, and timely service delivery
Develop and monitor key performance indicators, service level agreements, and operational dashboards
Identify trends, risks, and opportunities through ongoing analysis of departmental data
Lead process improvement initiatives that enhance efficiency, quality, and member experience
Evaluate workflows and implement operational best practices to support scalability and growth
Ensure consistency and quality across all prior authorization activities

Clinical Vendor & Partner Management

Serve as the primary relationship owner for clinical review vendors and other external partners
Establish performance expectations and monitor vendor outcomes, service levels, and quality measures
Collaborate with vendors to improve turnaround times, clinical consistency, and operational effectiveness
Evaluate vendor performance and identify opportunities for process enhancement or cost savings
Support implementation of new programs, technologies, and clinical initiatives involving external partners

Clinical Program Support

Collaborate with Clinical Programs leadership to ensure prior authorization processes align with formulary strategies, utilization management objectives, and client requirements
Provide clinical and operational consultation related to prior authorization programs
Support implementation of new clinical initiatives, products, and services
Ensure alignment between prior authorization operations and evolving client needs

Data Analytics & Continuous Improvement

Utilize operational and clinical data to identify opportunities for performance improvements
Develop reporting and insights to support decision-making and strategic planning
Monitor industry trends, emerging technologies, and best practices related to utilization management and prior authorization
Lead initiatives that improve automation, efficiency, quality, and member satisfaction
Partner with Technology and Operations teams to optimize systems and workflows

Cross-Functional Collaboration

Partner with Client Services, Operations, Member Care, Compliance, Technology, and Clinical teams to achieve organizational goals
Participate in client implementation activities as subject matter expert for prior authorization services
Support client audits, reporting requests, and operational reviews
Collaborate on enterprise initiatives impacting clinical operations and member experience

Compliance & Quality

Ensure department adherence to applicable regulatory, accreditation, and client requirements
Maintain policies, procedures, and operational standards related to prior authorization activities
Support quality assurance and audit activities
Identify and mitigate operational and compliance risks within the department
Promote a culture of quality, consistency, and continuous improvement

Requirements

Required

Bachelor of Science in Pharmacy (BSPharm) or Doctor of Pharmacy (PharmD)
Active pharmacist license in good standing
Minimum of 7-10 years of pharmacy, clinical operations, prior authorization, utilization management, or related healthcare experience
Minimum of 3-5 years of leadership experience with responsibility for team performance and operational outcomes
Demonstrated experience leading people, processes, and complex operational initiatives
Strong analytical and problem-solving skills
Experience using data to drive operational and business decisions
Excellent communication, presentation, and relationship management skills

Preferred

PBM experience
Prior authorization leadership experience
Utilization management experience
Multi-state operations experience
Experience managing external clinical vendors
Experience leading large-scale process improvement initiatives
Lean, Six Sigma, or related process improvement experience

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More about this job

Skills

Leadership
Team leadership
Quality assurance procedures
Process improvement
Regulatory compliance
Collaboration
Reporting
Decision making
Strategic planning
Quality assurance
Problem solving
Communication skills
Lean manufacturing

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