Director, Pharmacy Coverage Reviews

USARemote (US)director

Posted yesterday · via Workday

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About this role

Job Responsibilities Direct day-to-day operations for prior authorization and appeals programs, ensuring efficient, compliant, and member-focused service delivery. Maintain and enforce clinical coverage policies, ensuring adherence to regulatory and accreditation standards (URAC, NCQA, CMS). Lead and mentor managers and staff, setting clear performance expectations and fostering continuous improvement in service quality and turnaround times. Monitor utilization trends, turnaround metrics, and appeal outcomes to identify improvement opportunities and support affordability initiatives. Partner with clinical strategy, pharmacy benefit management, and compliance teams to align coverage review operations with enterprise goals.…

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