Remote 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

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.