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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.
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.
- 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.
Skills
- Clinical review
- Prior authorization
- Appeals
- Operational excellence
- Team development
- Clinical decision-making
- Managed care
- Utilization management
- People management
- Project management
- Key performance indicators (KPIs)
- Clinical criteria application
Location
- Remote (US, excluding AK, DE, HI, LA, MT, ND, OK, WV, WY, and US Territories)
Work Type
- Fully remote
- Occasional travel required
Experience Level
- 4+ years of experience in managed care performing clinical review/utilization management
- 1+ year(s) of people or project management experience
Education Level
- Doctor of Pharmacy Degree
Salary/Compensations
- California, Connecticut, New Jersey, New York, and Washington: $135,792.00 - $178,227.00 per year
- All other locations: $122,212.00 - $160,404.00 per year
Benefits
- Medical benefits
- Dental benefits
- Vision benefits
- 11 paid holidays
- Paid sick time
- Paid parental leave
- 401(k) plan participation
- Life insurance
- Disability insurance
- Paid wellness time and reimbursements
- Unlimited vacation program
- Annual performance bonuses
About the Company
- Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.
Equal Opportunity
- At Oscar, 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.
- Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation.
- For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.