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Director Insurance Prior Authorization Jobs in Florida

Spine Institute of Central Florida

Be Seen First

Prior Authorizations Specialist

Lakeland, FL · On-site

$16.75 - $22.25/hr

The Surgical Prior Authorizations Specialist will specialize in coordinating surgical prior ... Verify patient insurance coverage and eligibility to ensure proper authorization before procedures ...

Spine Institute of Central Florida

Be Seen First

Prior Authorizations Specialist

Lakeland, FL · On-site

$16.75 - $22.25/hr

The Surgical Prior Authorizations Specialist will specialize in coordinating surgical prior ... Verify patient insurance coverage and eligibility to ensure proper authorization before procedures ...

DeSoto Memorial

Authorization Specialist

Arcadia, FL · On-site

$16 - $21.25/hr

... prior authorization, and referral requirements across various payer types, including commercial, Medicare, and Medicaid plans. * Ability to accurately document clinical, insurance, and authorization ...

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Director Insurance Prior Authorization information

What does a director insurance prior authorization do?

A Director of Insurance Prior Authorization oversees the processes required to obtain insurance approvals for medical procedures, prescriptions, or treatments. They manage teams responsible for submitting prior authorization requests and ensure compliance with insurance guidelines and regulations. Their role includes improving workflow efficiency, reducing denials, and collaborating with healthcare providers and insurance companies. Additionally, they analyze trends to optimize the authorization process and provide training to staff on policy changes.

What is the difference between Director Insurance Prior Authorization vs Insurance Authorization Specialist?

AspectDirector Insurance Prior AuthorizationInsurance Authorization Specialist
CredentialsBachelor's degree, industry certifications often preferredHigh school diploma or equivalent, relevant certifications beneficial
Work EnvironmentManagement level, overseeing teams and processesOperational role, performing authorization tasks
Employer & Industry UsageHospitals, insurance companies, healthcare organizationsMedical offices, insurance companies, healthcare providers
Primary ResponsibilitiesOverseeing authorization processes, policy compliance, team managementProcessing authorization requests, verifying coverage, documentation

The main difference is that the Director Insurance Prior Authorization manages teams and oversees authorization policies, while the Insurance Authorization Specialist handles the day-to-day processing of authorization requests. Both roles require knowledge of insurance policies, but the director position involves leadership and strategic oversight.

What are the key skills and qualifications needed to thrive as a director insurance prior authorization?

To thrive as a Director of Insurance Prior Authorization, you need expertise in healthcare administration, insurance processes, and regulatory compliance, typically supported by a bachelor's or master's degree in healthcare or business administration. Familiarity with prior authorization software, electronic health records (EHRs), and payer systems is crucial for overseeing efficient authorization workflows. Strong leadership, problem-solving, and communication skills help drive team performance and manage complex stakeholder relationships. These skills ensure timely approvals, reduce claim denials, and maintain regulatory compliance, which directly impact patient access and organizational revenue.

What are some common challenges faced by a director insurance prior authorization, and how can they be effectively managed?

A Director of Insurance Prior Authorization often encounters challenges such as navigating constantly changing insurance requirements, ensuring timely approvals for patient care, and managing high volumes of authorization requests. Effective management involves staying updated on payer policies, implementing robust tracking systems, and fostering strong communication between clinical, administrative, and payer teams. Building a knowledgeable team and utilizing technology to streamline workflows can also help reduce denials and improve turnaround times.
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Director Insurance Prior Authorization jobs near you
Infographic showing various Director Insurance Prior Authorization job openings in Florida as of August 2026, with employment types broken down into 95% Full Time, and 5% Contract. Highlights an 100% In-person job distribution.

Director, Prior Authorization

EmpiRx Health, LLC

Orlando, FL • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 2 days ago

New

Job description

Director of Prior Authorization

EmpiRx Health is the leading clinically-driven pharmacy benefits management company. As the pioneer in value-based pharmacy care, EmpiRx Health puts its customers and members first by enabling them to take control of their pharmacy benefits, healthcare outcomes, and financial results.

We place more emphasis on member care than any other PBM by focusing on health outcomes first. Our pharmacists and clinicians are at the center of everything we do―and our population health solution delivers tailored strategies for our clients. Leveraging our newly launched, AI-powered pharmacy care platform, Clinically™, EmpiRx Health’s pharmacists and client experience teams provide the highest quality pharmacy care to our clients and their members. This enables benefits plan sponsors to keep their members healthy, happy, and productive, while substantially reducing prescription drug spending, which has been on an explosive growth trajectory in recent years.

The Director of Prior Authorization serves as the strategic and operational leader overseeing EmpiRx Health’s Prior Authorization and Appeals programs. This role manages a team of pharmacists and technicians responsible for clinical reviews, utilization management, and appeals processing while ensuring compliance with regulatory, clinical, and organizational standards. The Director will develop and optimize workflows, policies, and performance measures to drive operational excellence and ensure that prior authorization services deliver superior clinical quality and member satisfaction. As a key member of the Clinical Service/ Care Management leadership team, this individual will also partner cross-functionally with internal departments to advance efficiency, compliance, and innovation within EmpiRx Health’s utilization management framework.

Key Responsibilities:

Leadership and Team Management

  • Lead and mentor a team of Prior Authorization Pharmacists and Technicians to deliver efficient, compliant, and high-quality clinical review services.
  • Conduct performance evaluations, provide developmental feedback, and promote a collaborative, positive team culture.
  • Partner with the Vice President of Clinical Services to design and implement strategies that enhance prior authorization effectiveness and scalability.

Policy, Compliance & Quality Oversight

  • Develop, implement, and maintain standard operating procedures (SOPs) and policies that comply with federal, state, and PBM regulations.
  • Educate staff on changes in healthcare policy, pharmacy regulations, and EmpiRx Health internal procedures.
  • Oversee clinical audits, ensure documentation accuracy, and lead corrective action initiatives as needed.
  • Maintain high-quality performance by auditing cases for accuracy, completeness, and adherence to review guidelines.

Operational Excellence & Reporting

  • Monitor and analyze prior authorization performance metrics, turnaround times, and cost-savings impact.
  • Develop and deliver regular operational and performance reports for internal leadership and external stakeholders.
  • Leverage internal platforms (e.g., DOMO, Salesforce, Power BI) for workflow monitoring, trend analysis, and staff productivity tracking.
  • Identify process inefficiencies and implement continuous quality improvement initiatives to streamline workflows and enhance member experiences.

Cross-Functional Collaboration

  • Partner with other EmpiRx Health departments (e.g., Client Management, Population Health, Analytics, and IT) to align strategies and processes that support clinical and operational goals.
  • Provide clinical guidance and operational insights in support of client implementations, escalations, and renewals.
  • Collaborate with formulary management and clinical programs teams to ensure integration of prior authorization policies and clinical initiatives.

Clinical Expertise & Professional Development

  • Stay informed of drug pipeline developments, clinical guidelines, and regulatory updates through continuous education and professional memberships.
  • Use external resources such as IPD, UpToDate, and Medi-Span to support evidence-based clinical decision-making.
  • Support staff training initiatives and promote ongoing professional certification and development among team members.

Required Qualifications & Experience:

  • Bachelor of Pharmacy degree from an accredited institution.
  • Active Pharmacist License in good standing.
  • 5+ years of prior authorization experience within a PBM or health plan setting.
  • 10+ years of progressive management experience in healthcare or pharmacy operations.
  • Strong understanding of utilization management, formulary compliance, and appeals processing.
  • Advanced proficiency with Microsoft Office Suite (Excel, Word, PowerPoint) and pharmacy management systems.
  • Demonstrated ability to lead cross-functional teams, manage complex workflows, and deliver measurable outcomes.

Preferred Qualifications but Not Required

  • PharmD preferred.
  • MTM or specialty certification preferred.
  • Experience with DOMO, Salesforce, or other analytics/reporting tools.
  • Proven track record of managing hybrid or multi-location teams.


Work Environment: Hybrid on-site in Montvale, NJ


Compensation: 168-194K + 10% Bonus

Benefits And Perks

Subject to program eligibility, this position qualifies for a robust suite of benefits including Paid Time Off, a 401(k) program, Health Insurance including Dental & Vision coverage, Health Savings Account, and an Employee Assistance Program.


EmpiRx Health is an Equal Opportunity Employer

At EmpiRx Health, we wholeheartedly embrace the power of diversity and the magic of inclusion. The kaleidoscope of unique perspectives, backgrounds, and talents fuels our innovation and sets us apart. We're on a mission to build a team as diverse as the world we serve, where everyone is welcome and celebrated. We're not just breaking down barriers; we're actively erasing them to create an environment where opportunity knows no bounds. In unity, we find our strength and invite individuals from all walks of life to join us in our exhilarating journey to shape a brighter, more inclusive future together.

Note: This job description is a general outline of responsibilities and qualifications for the role. Additional duties may be assigned, and the position may evolve to meet the organization's needs.Top of Form