Manager, Prior Authorization Relations

Location: Remote (For Non-Local) or Hybrid (Local to NYC area)

Position Summary:

We are seeking a Prior Authorization (PA) Relations Manager to oversee the development, maintenance, and delivery of clinical resources and training programs related to prior authorization (PA) processes. In this role, you will manage a team of PA pharmacist and technician trainers, and collaborate closely with cross-functional teams to ensure that PA resources are up-to-date, clear, and aligned with the latest procedures and regulations. The ideal candidate will have excellent written communication and oral presentation skills, with a strong background in training, creating and maintaining process documents, and proficiency with design tools to develop and deliver impactful content.

Key Responsibilities:

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  Support the creation and development of internal training materials, job aids, and documentation to ensure clarity, consistency, and compliance with PA processes.

  
  

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  Collaborate with cross-functional teams to ensure documentation is updated regularly to reflect evolving prior authorization requirements and procedures.

  
  

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  Collaborate with the PA Operations and Quality Assurance teams, Managers, to ensure all training materials and documentation are updated regularly to meet high standards of accuracy, compliance, and reflect the latest procedures, regulations, and best practices.

  
  

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  Oversee and manage a team of PA pharmacist and PA tech trainers, ensuring they have the tools, resources, and support to effectively train internal teams.

  
  

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  Develop and update clear, accurate, and comprehensive training resources (e.g., guides, presentations) that explain PA processes and solutions for both internal and external teams.

  
  

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  Develop and create client-facing training resources that clearly explain PA processes, while tailoring these materials to meet the unique needs of clients, ensuring they are easily understandable and actionable.

  
  

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  Present training materials, process overviews, and PA-related content to both internal teams and clients, ensuring clear understanding and effective adoption of PA processes.

  
  

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  Proofread and review member and prescriber notification templates to ensure they are accurate, clear, and compliant with PA processes, regulations, and best practices.

  
  

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  Assist with new client implementation by developing post-implementation training materials based on initial PA process setup, ensuring PA team is equipped with the necessary knowledge to succeed.

  
  

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  Create dynamic process overviews, workflows, and other visual materials (using tools like Visio, Lucid, Canva, Figma, Miro, etc.) to facilitate training and enhance understanding of PA processes for both internal teams and clients.

  
  

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  Partner with other teams across the organization to ensure comprehensive training on PA processes and to address any cross-departmental needs related to PA.

  
  

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  Host and develop webinars, workshops, and training sessions to educate internal teams and clients on PA-related topics, ensuring clarity and knowledge retention.

  
  

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  Managing the relationship with external utilization management support vendors

  
  

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  Continuously assess training effectiveness and adjust to improve content, delivery methods, and learning outcomes.

  
  

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  Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance.

  
  

Education & Experience:

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  Minimum of 2 years of experience in a PBM or Health Plan, with a strong clinical background and a focus on prior authorization and training development.

  
  

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  Bachelor's in pharmacy or Pharm D

  
  

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  Experience managing or leading training teams is preferred.

  
  

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  Proven experience in creating and maintaining technical documentation such as job aids, manuals, and standard operating procedures.

  
  

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  Proven ability to work cross-functionally with other departments, especially in a client-facing capacity, is a plus.

  
  

Skills & Competencies:

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  Excellent written and oral communication skills, with the ability to distill complex information into clear, actionable content for diverse audiences.

  
  

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  Proficient in PowerPoint and experienced with design tools such as Canva, Lucid, Visio, Miro, Prezi, Balsamiq, Figma, Sketch, or similar platforms to create dynamic, visually engaging workflows, charts, and process overviews.

  
  

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  Strong experience in training development, including creating training materials and facilitating workshops, webinars, and other educational sessions.

  
  

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  Document editing expertise, with an eye for detail to ensure all training materials are polished, accurate, and well-organized.

  
  

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  Strong organizational skills and the ability to manage multiple projects and priorities in a fast-paced environment.

  
  

If you are a licensed pharmacist with a passion for training, process improvement, and collaboration, we encourage you to apply. Join us and play a key role in shaping the future of prior authorization training!

Base Salary: $120,000 - $150,000

Visa Sponsorship: Capital Rx does not provide sponsorship to any candidates. This includes, but is not limited to those that require H1-B, TN, OPT, etc. Candidates must have authorization to work in the US at the time of application and throughout employment.

This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

About Capital Rx

Capital Rx is a health technology company providing claim administration and technology solutions for carriers, health plans, TPAs, employer groups, and government entities. As a public benefit corporation, Capital Rx is executing its mission to materially reduce healthcare costs as a full-service PBM and through the deployment of Judi, the company's cloud-native enterprise health platform. Judi connects every aspect of the healthcare ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of benefits and rebuilding trust in healthcare.

Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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