The Associate Director, Patient Access, RPh leads the day-to-day operations of prior authorization and appeals teams supporting pharmacy-benefitted rare disease therapies. This role translates patient-access strategy into reliable operational execution by managing supervisors, monitoring queue performance, resolving access barriers, reinforcing payer-specific workflows, and ensuring timely, accurate, and compliant prior authorization and appeal activity.
Key Responsibilities
- Lead daily prior authorization and appeals operations, including supervisor performance, queue prioritization, staffing coverage, workload balancing, productivity, and service-level performance.
- Ensure teams interpret payer requirements accurately, prepare complete prior authorization submissions and appeal packets, maintain appropriate follow-up, and elevate complex access barriers successfully.
- Monitor queue aging, turnaround times, approval and denial trends, appeal outcomes, productivity, quality results, and service-level performance; identify risks and implement corrective actions.
- Reinforce adherence to standard operating procedures, documentation standards, HIPAA requirements, payer rules, quality audits, coaching plans, and training expectations.
- Partner across clinical and operational functions to resolve workflow gaps, payer barriers, documentation issues, and program launch-readiness needs.
- Set clear expectations, develop supervisors, reinforce accountability, and foster consistent, patient-centered team performance.
- Perform other duties and responsibilities as required.
Required Qualifications
- Doctor of Pharmacy (PharmD) degree from an accredited college or school of pharmacy.
- Ability to maintain pharmacist licensure as required for the assigned state or jurisdiction.
- Five to eight years of relevant professional experience.
- One to three years of people-management, supervisory, or team-lead experience.
Skills and Competencies
- Strong knowledge of pharmacy-benefit prior authorizations, appeals, payer requirements, and patient-access workflows.
- Experience leading teams in high-volume, service-level-driven operations.
- Ability to translate performance data into clear priorities and practical operational improvements.
- Sound judgment in resolving complex clinical, documentation, and payer-related barriers.
- Clear, collaborative communication across clinical, operational, technical, and external-partner teams.
- A disciplined approach to quality, compliance, coaching, and change management.
- A patient-centered mindset and an understanding of the urgency and complexity of rare disease care.
Work Requirements
- Work arrangement may be onsite, hybrid, or remote, depending on the role's designation and business needs.