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About Us

At Gifthealth, we're revolutionizing the way people experience healthcare by simplifying the process of managing prescriptions and health services. Our mission is to provide a seamless, personalized, and efficient healthcare experience for all our customers. We're a dynamic, innovative, and customer-centric company dedicated to making a positive impact on people's lives.

Position Summary

The Director of Patient Access owns and continuously strengthens the prior authorization operating system that stands between a written prescription and a patient starting therapy. Working lateral to the Director of Patient Experience, this leader owns a large, multi-tiered team, including the staff who work directly with manufacturer Field Reimbursement Manager (FRM) teams, and is accountable for reliable, timely, and accurate prior authorization performance across programs.

This role exists because every day a PA sits unresolved is a day a patient waits for medication they need now. The mandate is speed, accuracy, visibility, and relentless follow-through. The Director builds a management system in which leaders can see the work, manage exceptions, solve problems at the right level, and escalate when broader authority or systemic change is required.

Key Responsibilities

Prior Authorization Performance & FRM Partnership

• Own PA turnaround time (TAT) and queue health. Set and manage program-appropriate TAT and aging targets, monitor performance and outliers, and ensure corrective action when trends slip.

• Serve as the primary FRM point of contact and owner of the FRM partnership model. Build and maintain working relationships with Field Reimbursement Manager teams across manufacturer partners, with clear communication and escalation pathways that keep PA and appeals workflows aligned end to end.

• Troubleshoot high-priority and systemic PA issues in real time. Lead root-cause investigation on stalled, denied, or escalated PAs, including payer rejections, data mismatches, and missing documentation, and ensure the right operational owner drives resolution and preventive action.

• Own complex escalations and escalation standards. Coordinate high-visibility issues across Client Success, Pharmacy Operations, Quality, and manufacturer partners. Ensure recurring escalations trigger root-cause analysis and systemic fixes, not repeated workarounds.

Data, Metrics & Continuous Improvement

• Review PA data and balanced performance metrics. Track approval and denial rates, TAT by program and payer, aging PAs, denial reason codes, and available quality or rework indicators, and turn trends into action, not just reporting.

• Maintain performance visibility. Partner with analytics and operations teams to ensure dashboards and management views provide timely visibility into queue health, exceptions, and performance risks so issues are caught early.

• Drive process improvement from current-state evidence. Validate how work actually moves through teams, systems, queues, and handoffs before redesigning. Use measurable pilots to reduce time-to-therapy and rework, then standardize and scale what works.

• Partner on workflow and automation improvements. Ensure automation improves reliability, exceptions remain visible, and clear human-rescue paths exist when standard workflows fail.

Team Leadership

• Own a large, multi-tiered Patient Access team. Lead the full team responsible for prior authorization and FRM-facing work, including Team Leads/Supervisors, FRM Liaisons, and PA Specialists/Coordinators, with clear performance expectations tied to TAT, quality, operating reliability, and patient outcomes.

• Develop team leads and supervisors as operational owners. Set the standard for leaders who run day-to-day PA operations, manage queues, coach their teams, solve issues within defined decision rights, and escalate with facts and a recommendation when broader authority is needed.

• Hire, coach, and manage at scale. Build hiring, onboarding, capacity planning, and performance management processes that work for a large team spanning multiple functions and shifts.

• Build bench strength. Create career pathing, cross-training, and skill development plans so the team can scale and remain resilient without depending on any one person.

Cross-Functional Partnership

• Partner closely with the Director of Patient Experience. Align PA performance with the broader patient journey and coordinate shared programs, measures, and handoffs between access and experience functions.

• Collaborate with Pharmacy Operations, Intake & Automation, Quality, and Client Success. Ensure PA workflows integrate cleanly with dispensing, automation, client expectations, and compliance requirements, with clear ownership across critical handoffs.

• Represent patient access performance. Provide a decision-relevant view of PA performance, patient access friction, risks, and improvement work for leadership updates, client reviews, and program launches.

What Success Looks Like

• PA turnaround time and aging improve toward program-appropriate targets, with quality and accuracy sustained.

• Preventable delays, rework, and recurring escalations decline as root causes are identified and addressed.

• FRM relationships are strong enough to surface and resolve issues before they become broader patient or program problems.

• Team leads and supervisors independently manage day-to-day performance, triage, escalation, and case closure within clear decision rights, with minimal executive intervention.

• Operational improvements are tested with defined measures and balancing measures before they are scaled.

• Patients start therapy faster, with fewer preventable delays and without compromising quality, compliance, or patient experience.

Qualifications

Education: Bachelor’s degree or equivalent combination of education and/or experience (Required)

Licensure: None

Experience: 5+ years in prior authorization, patient access, or reimbursement within specialty pharmacy, PBM, or manufacturer hub/FRM environments, including people leadership experience hiring, coaching, and managing performance through team leads or supervisors in a high-volume operation.

Knowledge, Skills, and Abilities — Must-Have:

• Direct experience managing or partnering closely with Field Reimbursement Manager (FRM) teams.

• Strong analytical skills; comfortable working in PA, TAT, aging, and performance data and turning it into action.

• Working knowledge of the payer and PBM landscape, prior authorization requirements, and specialty medication access barriers.

• Demonstrated ability to improve operational workflows using data, frontline input, and cross-functional partnership.

Knowledge, Skills, and Abilities — Nice-to-Have:

• Experience in a direct-to-patient (DTP) or specialty dispensing pharmacy environment.

• Familiarity with hub services, bridge programs, or manufacturer-sponsored patient access programs.

• Experience building or improving PA workflows, SOPs, performance management routines, or automation-enabled processes from the ground up.

Work Environment

Location: Remote.

Schedule: Full-time

May require availability or flexibility for escalations.

Regular meetings with the Patient Access, Patient Experience, and cross-functional leadership teams to ensure alignment.

Employment Classification

Status: Full-time

FLSA: Exempt

Equal Employment Opportunity (EEO) Statement

Gifthealth is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. All employment decisions are made without regard to race, color, religion, sex, sexual orientation, gender identity, transgender status, national origin, age, disability, veteran status, or any other legally protected status.

We celebrate diversity and are committed to creating an inclusive environment for all employees. If you do not meet every requirement but still feel you would be a great fit for this role, we encourage you to apply!

Disclaimer

This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities, duties, or skills required of personnel. Gifthealth reserves the right to modify job duties or descriptions at any time.