Associate Director Prior Authorizations Operations Remote

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Associate Director Prior Authorizations Operations Remote (2391105)

Associate Director Prior Authorizations Operations Remote - 2391105

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.

The Associate Director, Prior Authorization Operations leads a high-volume pharmacy prior authorization operation, setting direction for a team of leaders and a 100+ clinician and technician workforce. This role owns operational, quality, compliance, and financial performance and drives innovation and process improvement across the end-to-end prior authorization process. Partnering with Clinical Services, Client Services, Compliance, and Technology, this leader connects daily operations to enterprise strategy and helps enable technology solutions that improve the member, provider, and client experience. This is an opportunity for an aspiring leader ready to make a visible impact and grow toward broader leadership roles at OptumRx.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Lead 5+ direct reports and 100+ indirect pharmacists and technicians; coach, develop, and build a bench of future leaders
• Own end-to-end performance, including turnaround time, quality, productivity, service, and regulatory and contractual guarantees, through real-time inventory and queue management
• Partner with department leadership on volume forecasting, capacity and staffing plans, and budget management
• Drive innovation and continuous process improvement across the prior authorization process, to improve outcomes
• Partner with Technology and Product teams to define requirements, pilot and scale solution; lead change management and adoption across teams
• Serve as the clinical and operational escalation point for complex cases; represent PA Operations with Clinical Services, Client Services, Compliance, and in client meetings
• Maintain audit readiness and compliance with CMS, state, accreditation, and client requirements; monitor quality and safety trends and drive measurable action plans
• Build a culture of accountability, transparency, patient and workforce safety, well-being, and continuous improvement

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Doctor of Pharmacy (PharmD) or B.S. Pharmacy with an active, unrestricted pharmacist license, and:
  • 5+ years of pharmacist experience, including 3+ years in prior authorization or utilization management
  • 3+ years of people leadership experience, including leading teams through operational or process change
• In-depth clinical knowledge of disease states, pharmacotherapy, and current treatment guidelines, including specialty and high-cost therapies
• Ability to interpret complex clinical scenarios and apply medical necessity criteria, FDA labeling, and compendia to coverage decisions
• Proven record of delivering measurable improvements in turnaround time, quality, productivity, or cost in a regulated environment
• Demonstrated experience leading process improvement or technology-enabled initiatives from concept through measurable outcomes
• Solid executive communication skills, with the ability to turn clinical, operational, and data insights into clear recommendations for leaders and clients
• Solid data fluency with Excel, PowerPoint, Word, and Outlook; working proficiency with Microsoft Copilot or other company-approved AI tools
• Ability to work flexible hours between 7:00 AM and 7:00 PM, including weekends as business needs require

Preferred Qualifications:

• Lean, Six Sigma, Agile, or project management certification; MBA, MHA, or managed care residency
• 1+ year of client-facing experience presenting performance results and improvement plans
• PBM or managed care experience operationalizing clinical guidelines, formulary, and benefit design across Medicare Part D, Commercial, and/or Medicaid
• Hands-on experience deploying workflow automation or AI solutions in a clinical or operational setting

Financial acumen, including building business cases and quantifying ROI, cost-to-operate, and capacity impact

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 to $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call View phone number on click.appcast.io to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.