Senior Manager, Coverage Review Pharmacist

Who is Prescryptive? Prescryptive Health is a healthcare technology company delivering solutions that empower consumers. Prescryptive's secure, mobile-first products connect consumers, pharmacists, and employers, ultimately providing people with the information they need to make informed decisions and take control of their health. To learn more about Prescryptive Health, visit Prescryptive.com. About this role The Sr. Manager, Customer Review Pharmacist leads Prescryptive's Prior Authorization and Coverage Review team, ensuring every coverage determination is accurate, compliant, and member-centered. This leader manages pharmacists and pharmacy technicians who deliver high-quality, timely coverage reviews. This role combines deep clinical expertise with operational leadership-improving how Prescryptive delivers safe, efficient, and transparent decisions through digital innovation and automation. The Sr. Manager drives quality, performance, and operational adherence to ERISA, URAC, and all external and internal standards while fostering a culture of accountability, continuous improvement, and empathy for those we serve. As part of an early-stage company, this leader operates with 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 you will do Key Accountabilities Lead the Prior Authorization and Coverage Review function, ensuring clinical accuracy, operational compliance, and timely determinations. 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 standards aligned industry standards and 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, optimize workflows, 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 and Prescryptive's internal 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 and Prescryptive's strategic 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 to optimize digital 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 directly impacts patients and prescribers. What you will bring Doctor of Pharmacy (PharmD) required; active, unrestricted pharmacist license in good standing. 5+ years of clinical or PBM experience with demonstrated experience 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 of URAC or ERISA requirements, clinical policy criteria, and evidence-based decision-making. Experience developing, implementing, and maintaining SOPs, QA programs, and audit processes. Demonstrated proficiency with 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 comfort operating in 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 12 paid holidays 401k match plus 100% employer paid medical, dental, and vision premiums Company contribution to Health Savings Account Stock options Prescryptive is committed to fair pay practices. The projected annual salary for this position is $135K - 165K. When preparing an offer, we consider the candidates resume, experience, interview feedback, internal equity, and location. Prescryptive is an Equal Opportunity Employer. Prescryptive does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other basis covered by appropriate law. All employment is decided on the basis of qualifications, merit, and business need.