Clinical Pharmacist Supervisor - Prior Authorization

Oscar Health•New York, NY

3d•$122,212 - $178,227•Remote

About The Position

The Clinical Pharmacist Supervisor - Prior Authorization oversees a team of pharmacists performing clinical review for prior authorizations and appeals. This role will drive operational excellence, foster team development, and ensure sound, evidence-based clinical decision-making to consistently meet organizational performance objectives, regulatory standards, and quality goals. You will report into the Manager, Pharmacy Utilization Management. This position is fully remote and open to candidates residing in the U.S., excluding Alaska; Delaware; Hawaii; Louisiana; Montana; North Dakota; Oklahoma; West Virginia; Wyoming; and U.S. Territories. Daily work is completed from your home office, with occasional travel required for team meetings and company events.

Requirements

Doctor of Pharmacy Degree.
Active, unrestricted pharmacist license.
4+ years of experience in managed care performing clinical review/utilization management.
1+ year(s) of people or project management experience.

Nice To Haves

Experience managing a team of clinical pharmacists performing clinical review/utilization management operations.
Experience developing and managing key performance indicators/metrics for an operational team.
Strong clinical skills and experience applying clinical criteria in a clinical review setting.

Responsibilities

Manage daily workflows, queue monitoring, and scheduling to ensure the pharmacist team consistently meets clinical accuracy standards and response timelines.
Monitor productivity and quality metrics, providing routine 1-on-1 coaching, performance reviews, and cross-training to help team members build clinical skills, step into expanded roles, and prepare for market expansion.
Serve as a clinical expert to review, troubleshoot, and resolve complex, high-priority prior authorization cases and appeals.
Collaborate with the Clinical Quality team on routine reviews, using audit findings to deliver constructive coaching, training, and performance support.
Proactively identify and implement process improvements, and resolve day-to-day challenges to keep the team operating efficiently.
Partner with cross-functional leadership to develop, update, and organize job aids and team training resources.
Participate in a rotated weekend and holiday on-call schedule to monitor queues and offer team support when needed.
Compliance with all applicable laws and regulations
Other duties as assigned