Director, Pharmacy Coverage Reviews

Location: Remote within the USA, with the role listed in Chattanooga, Tennessee

Company

hirify.global is a health insurance organization providing member-focused healthcare coverage and managed care services.

What you will do

• Direct daily operations for prior authorization and appeals programs.
• Maintain clinical coverage policies and ensure compliance with URAC, NCQA, CMS, and audit requirements.
• Lead and mentor managers and staff while setting performance expectations.
• Monitor utilization trends, turnaround metrics, and appeal outcomes to identify improvement opportunities.
• Partner with clinical strategy, pharmacy benefit management, and compliance teams.
• Improve coverage review processes through technology adoption, workflow optimization, and best-practice integration.

Requirements

• Doctor of Pharmacy degree (PharmD) required.
• At least 8 years of clinical experience.
• At least 6 years of practical experience in a managed care environment.
• At least 4 years of supervisory or leadership experience.
• Experience leading coverage review operations, implementing policies, analyzing utilization and performance data, and driving process improvements.
• Must be licensed in Tennessee to practice pharmacy or eligible for Tennessee pharmacy licensure.

Culture & Benefits

• Full-time employee position.
• Member-focused and compliance-oriented operating environment.
• Emphasis on continuous improvement, service quality, and turnaround performance.
• Cross-functional collaboration across clinical, pharmacy benefit management, compliance, and enterprise teams.