Clinical Pharmacist Supervisor - Prior Authorization

Oscar-Health-; New York (NY); Remote; USD 122,000 - 178,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) plan

11 paid holidays

Paid sick time

Paid parental leave

Wellness time and reimbursements

Job summary

Oscar Health is seeking a Clinical Pharmacist Supervisor - Prior Authorization to lead the Pharmacy Utilization Management team. You will oversee clinical reviews for prior authorizations and appeals, drive operational excellence, and mentor pharmacists to maintain high-quality, evidence-based decisions.

The role is fully remote in the United States (excluding certain states) and requires strong leadership, experience in managed care, and a Doctor of Pharmacy degree.

Qualifications

• Doctor of Pharmacy Degree required.
• 4+ years of experience in managed care performing clinical review/utilization management.
• 1+ year of people or project management experience.
• Experience leading a team of clinical pharmacists in utilization management operations.
• Experience developing and managing KPIs/metrics for an operational team.
• Strong clinical skills and ability to apply criteria in a clinical review setting.

Responsibilities

• Manage daily workflows, queue monitoring, and scheduling to ensure clinical accuracy and timely responses.
• Monitor productivity and quality metrics, providing routine 1-on-1 coaching and performance reviews.
• Review, troubleshoot, and resolve complex, high-priority prior authorization cases and appeals.
• Collaborate with the Clinical Quality team on audits and training improvements.
• Identify and implement process improvements to keep the team efficient.
• Partner with cross-functional leadership to develop training resources and job aids.
• Participate in rotated weekend and holiday on-call schedule as needed.
• Ensure compliance with applicable laws and regulations.
• Other duties as assigned.

Skills

Clinical review

Team leadership

Coaching

Process improvement

Education

Doctor of Pharmacy Degree

Job description

New York, New York, United States

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

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.

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 Oscar'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.
• 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.

This is an authentic Oscar Health job 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.

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: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team ([e-mail]) to make the need for an accommodation known.

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Voluntary Self-Identification

For government reporting purposes, we ask candidates to respond to the below self‑identification survey.Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiringprocess or thereafter. Any information that you do provide will be recorded and maintained in aconfidential file.

As set forth in Oscar Health’s Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law.

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measurethe effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categoriesis as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service‑connected disability.

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An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.