House Rx

Prior Authorization Supervisor

Pittsburgh, PA

Sponsorship not specifiedDetected 5 days ago

Performance ManagementEpicCernerEHR/EMRPharmacy PracticeLeadershipCommunicationMentoringOrganizational Skills

About the role

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.
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
Serve as escalation point for complex, denied, or time-sensitive cases-leading appeals strategy and coordinating with prescribers and clinical staff as needed

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
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 are a data-driven problem solver who uses metrics to identify trends, prioritize work, and drive continuous improvement

direct specialty pharmacy experience required
Deep knowledge of specialty PA processes across commercial, Medicare Part B/D, and Medicaid payers
Experience with PA workflow tools, pharmacy management systems, and EMR platforms
You have experience with specialty drug categories such as oncology, immunology, neurology, or rare disease and understand the clinical nuances that drive PA outcomes
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
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
Exceptional organizational skills with the ability to manage competing priorities in a high-volume environment
Ideal candidates must be located in or willing to relocate to the Pittsburgh, PA area, but we will consider remote candidates for the right fit.

You are comfortable navigating pharmacy and EMR systems (e.g., QS1, PioneerRx, Epic, Cerner, Therigy, ScriptMed) and learning new technology quickly
Stay current on payer landscape changes, formulary updates, and specialty drug coverage policies and proactively translate these into updated workflows
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

We are seeking an experienced Prior Authorization (PA) Supervisor to lead our onsite PA team at our Pittsburgh Hub.

This listing is sourced directly from House Rx's careers page and normalized into a canonical job model.