Director, Pharmacy Coverage Reviews

Location: Remote – US based candidates only, no visa sponsorship available

About the role

This role will lead operational priorities where safety, quality, compliance, and execution discipline are central to success. You will collaborate with field leadership, support functions, and cross-functional stakeholders to improve accountability, service delivery, and operational consistency. The position offers the opportunity to influence operational scale, customer outcomes, and organizational performance within a healthcare environment.

Responsibilities

• Direct day-to-day operations for prior authorization and appeals programs
• Maintain and enforce clinical coverage policies compliant with regulations
• Lead and mentor managers and staff to improve service quality
• Monitor utilization and appeal outcomes to identify improvement opportunities
• Partner with cross-functional teams to align operations with enterprise goals
• Ensure compliance with internal and external audit standards
• Drive process improvements through technology and workflow optimization

Requirements

• Doctor of Pharmacy Degree (PharmD) required
• Minimum 8 years clinical experience
• Minimum 6 years experience in a managed care environment
• Minimum 4 years in a supervisory or leadership role
• License to practice Pharmacy in Tennessee or eligibility for licensure

Pay

$120,000 – $145,000 annually

Benefits

• Health insurance
• Retirement plan
• Professional development opportunities
• Paid time off
• Employee wellness programs