Who isPrescryptive?
PrescryptiveHealth is a healthcare technologycompany deliveringsolutions that empower consumers.Prescryptive’ssecure, mobile-first products connect consumers, pharmacists, and employers,ultimately providingpeople with the information they need to make informed decisions and take control of their health. To learn more aboutPrescryptiveHealth, visit Prescryptive.com.
About this role
The Sr. Manager, Customer Review Pharmacist leadsPrescryptive’sPrior Authorization and Coverage Review team, ensuring everycoveragedetermination isaccurate, compliant, andmember-centered. This leader manages pharmacists and pharmacy technicians who deliver high-quality,timelycoverage reviews.This role combines deep clinicalexpertisewith operational leadership—improving howPrescryptivedelivers safe, efficient, and transparent decisions through digital innovation and automation. The Sr. Manager drives quality, performance, and operational adherence toERISA, URAC,and all externaland internal standards while fostering a culture of accountability, continuous improvement, and empathy for those we serve.As part of an early-stage company, this leaderoperateswith both strategic range and tactical agility—able to zoom out to design scalable systems and zoom in when needed to guide complex case decisions firsthand.
What youwilldo
Key Accountabilities
- Lead the Prior Authorization and Coverage Review function, ensuring clinical accuracy, operational compliance, andtimelydeterminations.
- Manage and develop a team of pharmacists and pharmacy technicians, fostering clarity, ownership, and continuous improvement.
- Maintain operational excellence through standardized SOPs, QA programs, and documentation standardsalignedindustry standardsand internal requirements.
- Use AI and automation to enhance case triage, improve turnaround time, and strengthen decision quality.
- Partner cross-functionally with Clinical Operations, Compliance, and Technology to evolve criteria,optimizeworkflows, and advance the member experience.
Principal Duties, Responsibilities, Performance Expectations (Essential Functions):
- Lead the Customer Review team, providing clinical oversight, daily guidance, and professional development for pharmacists and pharmacy technicians.
- Ensure all prior authorization and coverage determinations meet turnaround time requirements andPrescryptive’sinternal quality standards.
- Review and approve complex or escalated prior authorization requests, providing clinical input on appeals and high-impact cases.
- Maintain and continuously improve standard operating procedures (SOPs), quality assurance (QA) programs, and audit processes that ensure operational accuracy, regulatory adherence, and consistency across the Customer Review function.
- Ensure operational compliance with turnaround time, documentation quality, and clinical criteria standards, partnering with the Compliance function on policy interpretation and audit readiness.
- Use AI-assisted tools to triage, evaluate, and document prior authorization cases, improving prioritization and efficiency.
- Translate clinical insights into evidence-based policy and criteria updates that reflect the latest guidelines andPrescryptive’sstrategic direction.
- Monitor service levels, documentation accuracy, and technician performance, making staffing or process adjustments as needed.
- Collaborate closely with Compliance, Technology, and Clinical Operations teams tooptimizedigital workflows, reduce administrative friction, and improve provider and member satisfaction.
- Champion a culture of clinical excellence and empathy, ensuring that every team member understands how their work directlyimpactspatients and prescribers.
What you willbring
- Doctor of Pharmacy (PharmD)required; active, unrestricted pharmacist license in good standing.
- 5+ years of clinical or PBM experience withdemonstratedexperience in prior authorization or coverage review.
- Proven ability to lead and coach clinical and technical staff in a performance-driven, quality-focused environment.
- Strong understanding ofURAC or ERISArequirements, clinical policy criteria, and evidence-based decision-making.
- Experience developing, implementing, andmaintainingSOPs, QA programs, and audit processes.
- Demonstratedproficiencywith AI decision-support or automation tools for clinical case management.
- Ability to balance member-first advocacy with regulatory adherence and benefit accuracy.
- Exceptional written and verbal communication skills; able to convey clinical determinations clearly to providers, members, and internal partners.
- Strong collaboration skills and comfortoperatingin a fast-paced, evolving organization.
Ideally you will also have
- Experience managing a prior authorization or coverage review function
- Background in policy and criteria development
- Familiarity with AI-enabled case management tools and digital workflow solutions
What we have to offer
- The opportunity to grow alongside an early-stage company shaking up a big, old-fashioned industry
- Flexible time off, including 12paid holidays
- 401k match plus 100% employer paid medical, dental, and visionpremiums
- Company contribution to Health Savings Account
- Stock options
Prescryptiveis committed to fair pay practices. The projected annual salary for this position is$135K - 165K.When preparing an offer, we consider thecandidatesresume, experience, interview feedback, internal equity, and location.Prescryptiveis an Equal Opportunity Employer.Prescryptivedoes not discriminateon the basis ofrace, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteranstatusor any other basis covered byappropriate law.
All employment is decidedon the basis ofqualifications, merit, and businessneed.
