Director, Drug Authorization

Director, Drug Authorization New Providence, NJ Job Details 8 hours ago Qualifications Athenahealth Vendor relationship building Revenue cycle management Appeals Master's degree in business administration Master's degree in business Insurance prior authorization Master of Health Administration Operations management Automation Vendor management Bachelor's degree in finance Healthcare Administration Regulatory compliance Bachelor's degree in business Ophthalmology Data reporting Finance 8 years Change management Team development Hiring Key Performance Indicators Bachelor's degree Operational risk mitigation Team management Mentoring Vendor relationship management Medical insurance appeals management Data analytics Bachelor's degree in healthcare administration Business Administration Quality systems Master's degree in healthcare administration Senior level AI Cross-functional collaboration Business Master of Business Administration Escalation handling Medical claim denial management Leadership Healthcare compliance Communication skills Cross-functional communication Supply chain collaboration Senior leadership

Full Job Description Overview:

This is an exempt on-site role, located at our New Providence CBO location. The Director, Drug Authorization is a senior leadership role responsible for the end-to-end strategy, performance, and scalability of drug authorization operations across a growing national network of retina and general ophthalmology practices. This role owns the authorization lifecycle—from benefits investigation through payer approval, denial mitigation, and post- approval optimization—to ensure timely patient access to therapy while supporting enterprise financial and operational objectives. The Director plays a vital role in developing and executing enterprise drug mix and Gross Profit per Injection (GPPI) strategies in close partnership with Supply Chain, Finance, RCM, and Clinical leadership, while leading a centralized authorization organization, deploying automation, and standardizing processes across acquisitions.

Responsibilities:

Role and Responsibilities:

Lead and execute enterprise drug authorization strategy across retina and ophthalmology service lines to ensure timely access to therapy and consistent payer compliance. Oversee a fully centralized Drug Authorization organization, including benefits investigation, prior authorizations, treatment eligibility documentation, denial management, and appeals. Partner with Supply Chain, Finance, RCM, and Clinical leadership to support development and execution of enterprise drug mix and GPPI strategies through authorization feasibility, payer policy insight, and operational execution. Design and scale standardized authorization workflows that reduce cycle time, mitigate treatment delays, and support rapid growth in injection volume and practice footprint. Develop and monitor enterprise KPIs including authorization turnaround time, pending and expiring authorizations, denial rates, payer-specific trends, and authorization-related revenue leakage. Lead evaluation and deployment of automation and AI-enabled tools to improve authorization throughput, accuracy, auditability, and cost efficiency. Serve as executive escalation point for complex payer issues, high-risk denials, and systemic authorization failures impacting patient care or revenue. Lead authorization strategy and execution for new practice acquisitions and de novo expansions, ensuring rapid integration into centralized workflows with minimal disruption. Establish quality assurance, compliance controls, and governance frameworks across all authorization processes. Manage vendor, payer, and third-party relationships related to authorization services, technology platforms, and reimbursement policy. Hire, develop, and mentor a high-performing leadership team; establish productivity benchmarks, performance standards, and career pathways. Provide regular executive reporting and insights on authorization performance, operational risk, and financial impact.

Qualifications:

Essential Qualifications:

Education:

Bachelor's degree in Business, Finance, Healthcare Administration, or related field required. Advanced degree (MBA, MHA) preferred.

Experience:

8-10+ years of progressive leadership experience in Revenue Cycle, Drug Authorization, or specialty pharmaceutical operations within a multi-site physician practice or healthcare services platform. Retina or ophthalmology experience strongly preferred.

Knowledge / Skills

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Experience:

Deep expertise in high-cost injectable drug authorization, payer policy interpretation, and reimbursement dynamics. Demonstrated ability to scale centralized authorization operations across a growing national provider network. Strong understanding of how authorization performance influences drug utilization, revenue integrity, and margin. Experience deploying automation, analytics, and EMR/PMS-integrated workflows (Athena preferred). Advanced data analysis, reporting, and executive communication skills. Proven leadership, change management, and cross-functional collaboration capabilities. Ability to balance patient access, clinical urgency, financial stewardship, and regulatory compliance.