Prior Authorization Strategy and Innovation Director

Job DescriptionDo you want to make an impact a team and be a health care innovator? The Prior Authorization Strategy and Innovation Director will lead a highly skilled team that is accountable for programs critical to the growth of our Pharmacy Benefits Management business. This team is responsible for the development, oversight and execution of the Prior Authorization Automation strategy and roadmap, electronic prior authorization (ePA), and ePrescribing programs. You will also work closely with business partners at all levels of the organization to understand the business, guide teams to solve problems, and present recommendations to senior leadership.Key responsibilities:- Manage existing initiatives which includes technologies such as artificial intelligence and predictive analytics. - Identify new bold and innovative initiatives and strategies that will create simplicity for our customers and colleagues through automation, data, and technology. - Provide strategic leadership to ensure that all initiatives support client, member, prescriber, regulatory, and operational goals, and objectives. - Support growth opportunities for new and existing clients and provides strategic leadership in the development of technology solutions to ensure accurate and compliant functionality. - Act as the subject matter expert and leverage key relationships across the enterprise to support our operations and clients in complex problem solving and the development of creative solutions. - Collaborate with enterprise business partners in Operations, Information Technology (IT), Process Innovation, Product, Health Care Benefits (HCB - Aetna), Account Management, Finance, HR, Regulatory Affairs, Legal, and other partners to lead strategies to deliver the lowest cost serve rate in the industry. - Partner with the Product and Sales/Account teams to develop and implement client delegated services strategies that will grow the number of lives covered.The successful candidate will use their excellent communication skills, critical thinking skills and superior problem-solving capabilities to determine root cause and propose possible solutions to meet our overall business and enterprise needs. You must be able to operate with a high level of flexibility to fulfill the complex needs of a production environment and our clients. This is a work from home opportunity.Required Qualifications10+ years of relevant work experienceCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications Experience in pharmacy, pharmacy management, formulary management, drug utilization, managed care pharmacy, pharmacy benefit management, and third party (benefit) administration preferred 4+ years of consulting experience in an operational environment 6+ years of leadership/management experienceEducation Bachelor's Degree or equivalent work experience Master's Degree preferredBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-10-04