Clinical Pharmacist Supervisor - Prior Authorization

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 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

Reporting to the Manager of Pharmacy Utilization Management, the Clinical Pharmacist Supervisor - Prior Authorization oversees a dedicated team of clinical pharmacists performing evidence-based prior authorization (PA) reviews and appeals. In this operational leadership role, you will manage daily queue workflows, monitor turn-around-time (TAT) compliance, drive clinical accuracy, and deliver 1-on-1 coaching to foster team development. You will also serve as the escalation point for complex clinical cases, partner with the Clinical Quality team on audit calibration, and participate in a rotated weekend/holiday on-call schedule.

Key Responsibilities

• Team Management & Daily Queue Operations: Oversee daily pharmacy utilization management workflows, queue tracking, and pharmacist scheduling to ensure compliance with clinical accuracy standards and strict turnaround timelines.
• Performance Coaching & Clinical Mentorship: Track individual and team productivity/quality metrics; conduct routine 1-on-1 coaching, performance evaluations, and cross-training to expand team clinical capabilities.
• Complex Case Escalation: Serve as the clinical SME to review, troubleshoot, and resolve complex, high-priority prior authorization requests, provider appeals, and clinical determination exceptions.
• Quality Assurance & Audit Collaboration: Partner with the Clinical Quality team to review audit findings, translating insights into constructive coaching, training modules, and workflow adjustments.
• Process Optimization & Job Aids: Identify operational friction points, update team job aids, streamline review protocols, and implement continuous process improvements.
• On-Call Availability: Participate in a rotated weekend and holiday on-call schedule to monitor urgent authorization queues and provide escalation support to team members.

Requirements

Licensure, Education & Managed Care Experience

• Education: Doctor of Pharmacy (PharmD) degree from an accredited institution.
• Licensure: Active, unrestricted state Pharmacist license.
• Managed Care Expertise: 4+ years of direct experience in managed care, specifically performing clinical reviews and pharmacy utilization management (PA/appeals).
• Leadership Experience: 1+ year(s) of direct people management, supervisory, or project leadership experience.

Work Logistics & Location Eligibility

• Must reside in an eligible U.S. state (open to all U.S. states except Alaska, Delaware, Hawaii, Louisiana, Montana, North Dakota, Oklahoma, West Virginia, Wyoming, and U.S. Territories).
• Ability to complete daily work from a secure home office, with occasional travel for team offsites and company events.

Preferred Qualifications

• Direct experience supervising a remote team of clinical pharmacists within managed care, PBM, or health plan utilization management operations.
• Demonstrated success establishing and managing operational Key Performance Indicators (KPIs) and quality SLAs.
• Advanced clinical decision-making skills with deep familiarity applying evidence-based formulary guidelines and CMS/state regulatory criteria.

Total Rewards & Benefits

• Compensation: Base salary of $122,212.00 – $178,227.00 USD (tier based on state location) + annual performance bonus eligibility.
• Time Off & Flexibility: Participation in Oscar's Unlimited Vacation Program, 11 paid holidays, paid sick time, and paid wellness reimbursements.
• Comprehensive Healthcare: Top-tier medical, dental, and vision health coverage, plus life and disability insurance.
• Family & Financial Support: Paid parental leave, 401(k) retirement savings plan participation with match, and wellness reimbursements.