Manager, Prior Authorization

knownwell; United States; Remote; USD 90,000 - 130,000; Full time

Benefits offered by this job

Remote work

Insurance benefits

401K match

PTO and holidays

Parental leave

Job summary

knownwell is seeking a Manager, Prior Authorization to lead a team responsible for securing insurance approval for obesity management medications and care plans. This is a high-visibility operational leadership role impacting patient access and outcomes.

You will manage both in-house and outsourced resources, own vendor relationships, and drive continuous improvement in how requests are tracked, escalated, and resolved.

Qualifications

• 5-7 years of prior authorization experience, including 3+ years in a leadership role managing a Prior Authorization or similar insurance-facing operations team.
• Deep working knowledge of the Prior Authorization lifecycle and payer requirements.
• Experience managing distributed or blended teams (in-house + BPO/outsourced).
• Track record of building process and measuring it with structured tracking and metrics.

Responsibilities

• Manage and coach a team of Prior Authorization specialists across in-house and outsourced resources.
• Own outsourced staffing vendor relationship, including capacity planning and quality oversight.
• Own PA turnaround time, coverage rate, and backlog metrics; maintain visibility into team performance.
• Drive status tracking and work-list management in Athena and CoverMyMeds.
• Evolve PA competency frameworks, training materials, and SOPs for complex payer requirements.
• Partner with clinicians on complex cases and escalations.
• Identify and fix process or tooling breakdowns affecting patients.
• Lead hiring, onboarding, and ramp-up of new team members.
• Report PA performance and risk to Central Operations leadership.

Skills

Prior Authorization

Leadership

Vendor management

Process improvement

Cross-functional communication

Tools

CoverMyMeds

Athena

Job description

Meet knownwell, weight-inclusive healthcare for all. Join a dynamic company that is changing the way obesity care is delivered. We offer weight management, primary care, nutrition counseling, and health coaching. Our care model combines in-clinic and virtual care to bring support to patients where and when they need it.

Backed by $50M in funding—including a $25M round led by CVS Health Ventures with support from a16z Bio + Health, Flare Capital, MassMutual, and Intermountain Ventures—we’re scaling fast and expanding access to evidence-based obesity care nationwide.

We are looking to build our team with a Manager, Prior Authorization to lead the team responsible for securing insurance approval for patients' obesity management medications and other prescribed treatments. This is a high-visibility operational leadership role: Prior Authorization turnaround time and communication directly shape whether patients can start and stay on their prescribed care plan, and this role owns that outcome end to end.

You’ll manage a team of Prior Authorization specialists across in-house and outsourced/BPO resources, own the vendor relationship for outsourced capacity, and drive continuous improvement in how the team tracks, escalates, and resolves authorization requests. You’ll report into Central Operations leadership and work cross-functionally with clinicians, Patient Experience Coordinators, and Patient Access.

You Will:

• Manage and coach a team of Prior Authorization specialists, including performance management, scheduling/coverage planning, and staffing continuity across in-house and BPO/EOR resources.

• Own the outsourced staffing vendor relationship, including capacity planning and quality oversight.

• Own Prior Authorization turnaround time, coverage rate, and backlog metrics; build and maintain visibility into team performance for leadership.

• Drive structured status tracking and work-list management in Athena and CoverMyMeds, ensuring every request has a clear, current status and owner.

• Own and evolve Prior Authorization competency frameworks, training materials, and SOPs so the team handles complex payer requirements (including GLP-1 and other obesity management medication authorizations) consistently and correctly.

• Partner directly with clinicians on cases with unusual complexity or turnaround/communication issues, exercising independent judgment on escalations and physician relations.

• Identify and fix breakdowns in process or tooling (e.g., macros, escalation paths, notification workflows) that create patient-facing failures.

• Lead hiring, onboarding, and ramp-up of new Prior Authorization team members.

• Report on Prior Authorization performance and risk to Central Operations leadership, flagging staffing or payer-side issues early and proactively.

You Have:

• 5-7 years of prior authorization experience, including 3+ years in a leadership role managing a Prior Authorization or similar insurance-facing operations team.

• Deep working knowledge of the Prior Authorization lifecycle, payer requirements, and tools like CoverMyMeds and an EHR (Athena strongly preferred).

• Experience managing distributed or blended teams (in-house + BPO/outsourced), including vendor management.

• A track record of building process and measuring it — you default to structured tracking and metrics, not tribal knowledge.

• Strong cross-functional communication skills; comfortable being the connective tissue between clinicians, operations, and patients.

• Calm under staffing or volume pressure, with a bias toward fixing root causes rather than patching symptoms.

• Familiarity with GLP-1s or obesity management medications, and a genuine investment in weight-inclusive, patient-centered care, is a strong plus.

Pay & Perks:

Fully remote opportunity

Medical, dental, and vision insurance

401K retirement plan with company match

Up to 20 days of PTO per year + company holidays

Up to 14 weeks of parental leave (12 for non-birthing parents)

Annual work from home stipend for remote employees

knownwell, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. Based on current size of the clinic and HIPAA regulation, providers cannot receive care in clinic and provider’s household members cannot receive primary care in the clinic.