Clinical Pharmacist Supervisor – Prior Authorization

🔥 8 minutes ago

🇺🇸 United States – Remote

💵 $135.8k - $178.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

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Oscar Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2012

⚕️ Healthcare Insurance

🏥 Healthcare

💰 $355M Post-IPO Debt - Oscar Health on 2025-09

Healthcare Insurance • Healthcare

Oscar Health is a technology-driven health insurance company that provides individual, family, and small-group health plans in multiple U. S. states. Oscar combines traditional insurance underwriting with digital-first services — a consumer-facing app, 24/7 virtual urgent care, prescription delivery (including $3 meds in many plans), and dedicated Care Teams — and also operates Oscar Primary Care in some markets. The company emphasizes accessible, affordable, high-quality care and uses AI to improve member experience and care delivery. Insurance policies are underwritten by Oscar's state insurance subsidiaries and the company offers both HMO and other plan types across its markets.

📋 Description

• Oversee a team of pharmacists performing clinical review for prior authorizations and appeals • Manage daily workflows, queue monitoring, and scheduling • Ensure the pharmacist team meets clinical accuracy standards and response timelines • Monitor productivity and quality metrics • Provide 1-on-1 coaching, performance reviews, and cross-training • Review, troubleshoot, and resolve complex, high-priority prior authorization cases and appeals • Collaborate with the Clinical Quality team on routine reviews • Deliver coaching, training, and performance support based on audit findings • Identify and implement process improvements • Partner with cross-functional leadership to develop and organize job aids and training resources • Participate in a rotated weekend and holiday on-call schedule • Ensure compliance with applicable laws and regulations • Report to the Manager, Pharmacy Utilization Management

🎯 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 (bonus points) • Experience developing and managing key performance indicators/metrics for an operational team (bonus points) • Strong clinical skills and experience applying clinical criteria in a clinical review setting (bonus points)

🏖️ Benefits

• Employee benefits • Unlimited vacation program • Annual performance bonuses • 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 • Occasional travel for team meetings and company events

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