What are the responsibilities and job description for the Director, Drug Authorization position at Prism Vision Group?
Overview:
This is an exempt on-site role, located at our New Providence CBO location.
The Director, Drug Authorization is a senior leadership role responsible for the end-to-end strategy, performance, and scalability of drug authorization operations across a growing national network of retina and general ophthalmology practices. This role owns the authorization lifecycle—from benefits investigation through payer approval, denial mitigation, and post-
approval optimization—to ensure timely patient access to therapy while supporting enterprise financial and operational objectives. The Director plays a vital role in developing and executing enterprise drug mix and Gross Profit per Injection (GPPI) strategies in close partnership with Supply Chain, Finance, RCM, and Clinical leadership, while leading a centralized authorization organization, deploying automation, and standardizing processes across acquisitions.
Responsibilities:
Essential Qualifications:
Education: Bachelor’s degree in Business, Finance, Healthcare Administration, or related field required. Advanced degree (MBA, MHA) preferred.
Knowledge / Skills / Experience:
This is an exempt on-site role, located at our New Providence CBO location.
The Director, Drug Authorization is a senior leadership role responsible for the end-to-end strategy, performance, and scalability of drug authorization operations across a growing national network of retina and general ophthalmology practices. This role owns the authorization lifecycle—from benefits investigation through payer approval, denial mitigation, and post-
approval optimization—to ensure timely patient access to therapy while supporting enterprise financial and operational objectives. The Director plays a vital role in developing and executing enterprise drug mix and Gross Profit per Injection (GPPI) strategies in close partnership with Supply Chain, Finance, RCM, and Clinical leadership, while leading a centralized authorization organization, deploying automation, and standardizing processes across acquisitions.
Responsibilities:
Role and Responsibilities:
- Lead and execute enterprise drug authorization strategy across retina and ophthalmology service lines to ensure timely access to therapy and consistent payer compliance.
- Oversee a fully centralized Drug Authorization organization, including benefits investigation, prior authorizations, treatment eligibility documentation, denial management, and appeals.
- Partner with Supply Chain, Finance, RCM, and Clinical leadership to support development and execution of enterprise drug mix and GPPI strategies through authorization feasibility, payer policy insight, and operational execution.
- Design and scale standardized authorization workflows that reduce cycle time, mitigate treatment delays, and support rapid growth in injection volume and practice footprint.
- Develop and monitor enterprise KPIs including authorization turnaround time, pending and expiring authorizations, denial rates, payer-specific trends, and authorization-related revenue leakage.
- Lead evaluation and deployment of automation and AI-enabled tools to improve authorization throughput, accuracy, auditability, and cost efficiency.
- Serve as executive escalation point for complex payer issues, high-risk denials, and systemic authorization failures impacting patient care or revenue.
- Lead authorization strategy and execution for new practice acquisitions and de novo expansions, ensuring rapid integration into centralized workflows with minimal disruption.
- Establish quality assurance, compliance controls, and governance frameworks across all authorization processes.
- Manage vendor, payer, and third-party relationships related to authorization services, technology platforms, and reimbursement policy.
- Hire, develop, and mentor a high-performing leadership team; establish productivity benchmarks, performance standards, and career pathways.
- Provide regular executive reporting and insights on authorization performance, operational risk, and financial impact.
Essential Qualifications:
Education: Bachelor’s degree in Business, Finance, Healthcare Administration, or related field required. Advanced degree (MBA, MHA) preferred.
Experience: 8–10 years of progressive leadership experience in Revenue Cycle, Drug Authorization, or specialty pharmaceutical operations within a multi-site physician practice or healthcare services platform. Retina or ophthalmology experience strongly preferred.
Knowledge / Skills / Experience:
- Deep expertise in high-cost injectable drug authorization, payer policy interpretation, and reimbursement dynamics.
- Demonstrated ability to scale centralized authorization operations across a growing national provider network.
- Strong understanding of how authorization performance influences drug utilization, revenue integrity, and margin.
- Experience deploying automation, analytics, and EMR/PMS-integrated workflows (Athena preferred).
- Advanced data analysis, reporting, and executive communication skills.
- Proven leadership, change management, and cross-functional collaboration capabilities.
- Ability to balance patient access, clinical urgency, financial stewardship, and regulatory compliance.