Remote Lead Pharmacist, Prior Authorization & Appeals

Oscar; United States; Remote; USD 122,000 - 178,000; Full time

Benefits offered by this job

Unlimited vacation

Annual performance bonus

Medical/dental/vision benefits

401(k) plan participation

Job summary

Oscar is hiring a Clinical Pharmacist Supervisor - Prior Authorization to join our Pharmacy Utilization Management team. This role oversees a team of pharmacists performing clinical reviews for prior authorizations and appeals, driving operational excellence, and ensuring sound, evidence-based clinical decision-making.

This fully remote position is open to candidates residing in the U.S., with some state restrictions; reporting to the Manager, Pharmacy Utilization Management.

Qualifications

• Doctor of Pharmacy Degree.
• Active, unrestricted pharmacist license.
• 4+ years of experience in managed care performing clinical review/usagement management.
• 1+ year(s) of people or project management experience.

Responsibilities

• Manage daily workflows, queue monitoring, and scheduling to 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.
• 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 for coaching and training.
• Identify and implement process improvements to keep the team efficient.
• Partner with cross-functional leadership to develop training resources.
• Participate in rotated weekend/holiday on-call schedule.
• Ensure compliance with all applicable laws and regulations.
• Perform other duties as assigned

Skills

Clinical leadership

Managed care

Team management

Prior authorization

Education

Doctor of Pharmacy Degree

Tools

Job description

Oscar is hiring a Clinical Pharmacist Supervisor - Prior Authorization to join our Pharmacy Utilization Management team. This role oversees a team of pharmacists performing clinical reviews for prior authorizations and appeals, driving operational excellence, and ensuring sound, evidence-based clinical decision-making.

This fully remote position is open to candidates residing in the U.S., with some state restrictions; reporting to the Manager, Pharmacy Utilization Management.