Clinical Pharmacist Supervisor - Prior Authorization

Hi, we're the company. We're hiring a Clinical Pharmacist Supervisor - Prior Authorization to join our Pharmacy Utilization Management team.

The company is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started the company in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role

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.

Work Location: 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. #LI-Remote

Pay Transparency: The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $135,792.00 - $178,227.00 per year. The base pay for this role in all other locations is: $122,212.00 - $160,404.00 per year. You are also eligible for employee benefits, participation in the company's unlimited vacation program, and annual performance bonuses.

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

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.

Bonus points

• 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.

This is an authentic the company job opportunity.

At the company, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency:  Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: the company applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any the company applicant who requires reasonable accommodations during the application process should contact the company Benefits Team [link for members] to make the need for an accommodation known.

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