Prior Authorization Pharmacist Supervisor

Oscar Health

Oscar Health

People & HR, Operations
Remote
Posted on Sunday, June 9, 2024

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

Oscar is the first health insurance company built around a full stack technology platform and a 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 Prior Authorization Pharmacist Supervisor will oversee the pharmacists performing clinical review of pharmacy authorizations and appeals to achieve overall performance objectives.

You will report to the Manager of Clinical Pharmacy.

Work Location:

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission.

If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.

You must reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role is: $131,200- $172,200 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities

  • Managing workflows, schedules, coaching/development, and clinical review stations for a team of pharmacists.
  • Support the pharmacist team by identifying issues, presenting resolutions, and preparing for expansion into new markets.
  • Develop existing team members to take on new processes.
  • Respond and resolve escalated issues related to prior authorizations and appeals.
  • Partner with clinical quality to administer and oversee monthly/quarterly clinical audits of pharmacists and lead remediation and coaching sessions.
  • Weekend/holiday on-call rotation to support queue monitoring and pharmacy team.
  • Provide support to project leads for clinical pharmacy operations such as: job aid maintenance, vendor issues management, policy owner, and training.
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Qualifications

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

Bonus Points

  • 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.
  • Acute attention to detail, excellent written and verbal communication skills.

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

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.

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 (accommodations@hioscar.com) to make the need for an accommodation known.