About the RoleWe are seeking an experienced Prior Authorization (PA) Supervisor to lead our onsite PA team at our Pittsburgh Hub. This is not a traditional people manager role-we are looking for a working supervisor who is a recognized subject matter expert in end to end specialty pharmacy prior authorization, from payer strategy and clinical criteria to appeal resolution. You will set the standard for the team by doing the work alongside them, while also building the systems, processes, and talent needed to scale a high-performing PA function.
This role reports to the Director, Centralized Clinical Services and is critical to delivering exceptional outcomes for our patients and clinic partners.
Key ResponsibilitiesPrior Authorization Expertise & Workflow Ownership- Serve as the team's primary SME for specialty PA workflows; including initial submissions, peer-to-peer coordination, appeals, and exception requests across commercial, Medicare, and Medicaid payers
- Maintain a working caseload to model best practices, demonstrate PA excellence, and stay current on payer policy changes and clinical criteria
- Develop, document, and continuously improve standard operating procedures (SOPs) for the full PA lifecycle, ensuring consistency and compliance across the team
- Ensure accuracy and timeliness of PA submissions by monitoring payer-specific requirements for specialty drug classes (e.g., oncology, immunology)
- Serve as escalation point for complex, denied, or time-sensitive cases-leading appeals strategy and coordinating with prescribers and clinical staff as needed
- Stay current on payer landscape changes, formulary updates, and specialty drug coverage policies and proactively translate these into updated workflows
Team Leadership & Development- Lead, coach, and develop a team of onsite and remote Care Coordinators working on the Prior Authorization team, fostering a culture of accountability, clinical excellence, and continuous improvement
- Conduct regular 1:1s and structured performance reviews to identify development opportunities, address performance gaps, and retain top talent
- Manage scheduling, PTO coverage, and workload distribution to ensure consistent service levels and team wellbeing
- Collaborate with the training lead to design and deliver PA-specific onboarding and ongoing education-including payer updates, denial trends, and documentation best practices
- Execute structured QA audits on PA submissions and outcomes; report metrics and drive corrective actions based on findings
- Champion team morale and a collaborative, patient-first culture
Operational Performance & Reporting- Track and report on key PA performance metrics including approval rates, turnaround times, denial rates, appeal success rates, and patient impact
- Partner with operations leadership to set and achieve productivity benchmarks, ensuring accountability across the team
- Identify patterns in denials and payer behavior to proactively address root causes and improve first-pass approval rates
- Support clinic launch readiness by ensuring PA workflows are fully established and operational before go-live
- Collaborate cross-functionally with care coordinators, pharmacists, and clinical operations to remove barriers in the patient access journey
- Provide subject matter expertise to client-facing teams during implementation, QBRs, and operational reviews as needed
About You- You have deep, hands-on experience managing specialty pharmacy prior authorizations-you know the end-to-end PA process inside and out, including appeals, peer-to-peers, and payer-specific nuances
- You are a proven leader who earns credibility through expertise, not just title-your team looks to you as a PA resource first, and a manager second
- You have managed or mentored a team of PA specialists and understand the balance between coaching others and maintaining your own clinical sharpness
- You thrive in a fast-paced, startup-style environment and are energized by building and improving systems from the ground up
- You have experience with specialty drug categories such as oncology, immunology, neurology, or rare disease and understand the clinical nuances that drive PA outcomes
- You are comfortable navigating pharmacy and EMR systems (e.g., QS1, PioneerRx, Epic, Cerner, Therigy, ScriptMed) and learning new technology quickly
- You are a clear, confident communicator-able to advocate for patients, align internal stakeholders, and speak credibly with clinic staff and prescribers
- You are a data-driven problem solver who uses metrics to identify trends, prioritize work, and drive continuous improvement
Qualifications- 5+ years of hands-on prior authorization experience in a specialty pharmacy, health system, or managed care setting; direct specialty pharmacy experience required
- 2+ years of supervisory or lead experience managing PA teams or workflows
- Deep knowledge of specialty PA processes across commercial, Medicare Part B/D, and Medicaid payers
- Demonstrated experience managing appeals, exception requests, and peer-to-peer coordination
- Strong understanding of clinical criteria, step therapy requirements, and medical necessity documentation for specialty therapeutics
- Experience with PA workflow tools, pharmacy management systems, and EMR platforms
- Exceptional organizational skills with the ability to manage competing priorities in a high-volume environment
- This is an onsite role; candidates must be located in or willing to relocate to the Pittsburgh, PA area
