Director, Utilization Management

The Director of Utilization Management at AffirmedRx is a senior clinical and operational leader responsible for developing and overseeing Prior Authorization (PA) operations. This role involves building a high-performing PA team, establishing efficient processes, and ensuring compliance with regulatory standards. AffirmedRx is a Public Benefit Corporation dedicated to improving healthcare outcomes by bringing clarity, integrity, and trust to pharmacy benefit management.

Key responsibilities include leading the PA team through hiring, training, and performance management, as well as developing scalable PA processes that integrate seamlessly with client systems. The Director will oversee clinical review activities, ensure timely communication of determinations, and collaborate with internal teams to implement changes and support process improvements.

The ideal candidate will have a Bachelor's degree in Pharmacy, with an advanced degree preferred, and over 10 years of experience in prior authorization operations or related roles, including at least 5 years in a leadership position. Experience in pharmacy benefit management is advantageous. A deep understanding of PA processes, regulatory requirements, and strong analytical and problem-solving skills are essential.

AffirmedRx offers competitive compensation, including health, dental, and vision benefits. The company fosters a culture where team members thrive, recognizing that when the team succeeds, the business succeeds.

As a mission-driven organization, AffirmedRx emphasizes transparency and patient-centric care. Joining the team provides an opportunity to impact industry change in pharmacy benefits management while delivering high-quality patient outcomes.