Prior Authorization Supervisor

House Rx•Pittsburgh, PA

1d•Onsite

About The Position

House Rx is seeking an experienced Prior Authorization (PA) Supervisor to lead their onsite PA team at their Pittsburgh Hub. This is a working supervisor role, requiring subject matter expertise in end-to-end specialty pharmacy prior authorization, including payer strategy, clinical criteria, and appeal resolution. The supervisor will set standards by performing the work alongside the team, while also developing systems, processes, and talent to scale the PA function. This role reports to the Director, Centralized Clinical Services and is crucial for delivering exceptional patient and clinic partner outcomes.

Requirements

5+ years of hands-on prior authorization experience in a specialty pharmacy, health system, or managed care setting; direct specialty pharmacy experience required.
2+ years of supervisory or lead experience managing PA teams or workflows.
Deep knowledge of specialty PA processes across commercial, Medicare Part B/D, and Medicaid payers.
Demonstrated experience managing appeals, exception requests, and peer-to-peer coordination.
Strong understanding of clinical criteria, step therapy requirements, and medical necessity documentation for specialty therapeutics.
Experience with PA workflow tools, pharmacy management systems, and EMR platforms.
Exceptional organizational skills with the ability to manage competing priorities in a high-volume environment.
Must be located in or willing to relocate to the Pittsburgh, PA area.
Deep, hands-on experience managing specialty pharmacy prior authorizations—knowing the end-to-end PA process inside and out, including appeals, peer-to-peers, and payer-specific nuances.
Proven leader who earns credibility through expertise, not just title—team looks to you as a PA resource first, and a manager second.
Experience managing or mentoring a team of PA specialists and understanding the balance between coaching others and maintaining your own clinical sharpness.
Thrive in a fast-paced, startup-style environment and are energized by building and improving systems from the ground up.
Experience with specialty drug categories such as oncology, immunology, neurology, or rare disease and understand the clinical nuances that drive PA outcomes.
Comfortable navigating pharmacy and EMR systems (e.g., QS1, PioneerRx, Epic, Cerner, Therigy, ScriptMed) and learning new technology quickly.
Clear, confident communicator—able to advocate for patients, align internal stakeholders, and speak credibly with clinic staff and prescribers.
Data-driven problem solver who uses metrics to identify trends, prioritize work, and drive continuous improvement.

Responsibilities

Serve as the team’s primary SME for specialty PA workflows; including initial submissions, peer-to-peer coordination, appeals, and exception requests across commercial, Medicare, and Medicaid payers.
Maintain a working caseload to model best practices, demonstrate PA excellence, and stay current on payer policy changes and clinical criteria.
Develop, document, and continuously improve standard operating procedures (SOPs) for the full PA lifecycle, ensuring consistency and compliance across the team.
Ensure accuracy and timeliness of PA submissions by monitoring payer-specific requirements for specialty drug classes (e.g., oncology, immunology).
Serve as escalation point for complex, denied, or time-sensitive cases—leading appeals strategy and coordinating with prescribers and clinical staff as needed.
Stay current on payer landscape changes, formulary updates, and specialty drug coverage policies and proactively translate these into updated workflows.
Lead, coach, and develop a team of onsite and remote Care Coordinators working on the Prior Authorization team, fostering a culture of accountability, clinical excellence, and continuous improvement.
Conduct regular 1:1s and structured performance reviews to identify development opportunities, address performance gaps, and retain top talent.
Manage scheduling, PTO coverage, and workload distribution to ensure consistent service levels and team wellbeing.
Collaborate with the training lead to design and deliver PA-specific onboarding and ongoing education—including payer updates, denial trends, and documentation best practices.
Execute structured QA audits on PA submissions and outcomes; report metrics and drive corrective actions based on findings.
Champion team morale and a collaborative, patient-first culture.
Track and report on key PA performance metrics including approval rates, turnaround times, denial rates, appeal success rates, and patient impact.
Partner with operations leadership to set and achieve productivity benchmarks, ensuring accountability across the team.
Identify patterns in denials and payer behavior to proactively address root causes and improve first-pass approval rates.
Support clinic launch readiness by ensuring PA workflows are fully established and operational before go-live.
Collaborate cross-functionally with care coordinators, pharmacists, and clinical operations to remove barriers in the patient access journey.
Provide subject matter expertise to client-facing teams during implementation, QBRs, and operational reviews as needed.