Pharmacy Prior Authorization Team Lead

Job Description

Location: Remote (US-based)

We are seeking a Prior Authorization Team Lead to manage a team of PA specialists while maintaining a personal caseload. This hybrid leadership role drives team performance, streamlines authorization workflows, and ensures patients receive timely access to specialty medications through efficient payer navigation and persistent follow-through.

This role is for someone who has mastered the prior authorization process and is ready to lead a team that does it at scale. You will coach your specialists through complex cases, manage the metrics that matter, and build the workflows that keep medications moving from prescriber to patient without unnecessary delays.

Responsibilities:

• Supervise and mentor a team of 6-10 prior authorization specialists handling specialty and high-cost medication authorizations
• Monitor team productivity metrics including turnaround times, approval rates, and appeals outcomes
• Manage personal caseload of complex or escalated prior authorization cases requiring clinical justification
• Develop and update standard operating procedures for PA intake, submission, and appeals processes
• Train new hires on payer portal navigation, clinical documentation requirements, and escalation protocols
• Collaborate with clinical pharmacists and prescribers to strengthen authorization submissions
• Track payer policy changes and formulary updates that impact authorization requirements across the book of business
• Prepare weekly performance reports and present team metrics to pharmacy leadership
• Conduct quality audits on authorization submissions and provide individualized feedback to team members
• Manage peer-to-peer review scheduling and preparation for denied authorization appeals
• Coordinate with hub services, patient access, and fulfillment teams on authorization status and patient communication
• Identify process bottlenecks and implement workflow improvements to reduce authorization cycle times
• Support accreditation compliance by maintaining authorization documentation to URAC/ACHC standards
• Serve as the escalation point for payer disputes, urgent authorization needs, and high-priority patient cases

Qualifications:

• Associate degree required; bachelor’s degree in healthcare or pharmacy preferred
• CPhT certification required
• Minimum 3 years of prior authorization experience in specialty pharmacy with at least 1 year in a lead or supervisory capacity
• Expert knowledge of specialty drug prior authorization processes across commercial, Medicare, and Medicaid payers
• Experience with pharmacy management systems, CRM platforms, and payer portals
• Strong coaching and team development skills with a metrics-driven mindset
• Excellent organizational skills for managing team workloads and competing priorities
• Strong communication skills for physician interactions, payer negotiations, and team leadership

Schedule:

• Full-time position
• Standard business hours
• Standard full-time hours per pay period

Salary Range: The salary range for this position is approximately $58,000 – $72,000 annually ($27.88 – $34.62 per hour), based on experience and qualifications. Relocation assistance may be available for qualified candidates.

Interview Process:

• Selected candidates will participate in a multi-step interview process, including an initial screening with TalentLNX followed by interviews with department leadership.

Equal Opportunity Employer: TalentLNX is committed to equal employment opportunity and prohibits discrimination and harassment of any kind. We are dedicated to building a diverse workforce and fostering an inclusive work environment where all employees and candidates are treated with respect and dignity. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or any other protected status under applicable law. We actively seek to recruit, develop, and retain talented individuals from diverse backgrounds and we encourage all qualified candidates to apply for our job opportunities.