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Prior Authorization Manager (US Healthcare)

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Job Description

Job Title: Specialty Pharmacy Operations Manager (Biologics & Prior Authorization)

Location: Remote

Salary: $3,500 – $4,900 USD/month

Schedule: Monday – Friday, 9:00 AM – 5:00 PM (EST)

Type: Independent Contractor

Role Overview

This is a Specialty Pharmacy Operations Manager role focused on owning biologics prescription workflows, prior authorization performance, and time-to-therapy execution.

You will manage the end-to-end lifecycle of specialty prescriptions (Rx → approval → dispensing → treatment), ensuring every prescription is tracked, processed, and converted into active therapy.

This is a high-ownership operations role, responsible for pipeline visibility, payer coordination, and dispensing optimization across providers, pharmacies, and internal teams.

What You'll Own

  • Own the full prescription pipeline from Rx creation to patient on therapy
  • Ensure 100% tracking, status clarity, and accountability across all prescriptions
  • Manage and optimize prior authorization workflows, escalations, and approvals
  • Reduce time-to-therapy and rework rates across the pipeline
  • Identify and eliminate specialty pharmacy leakage, increasing internal dispensing
  • Build and maintain medication routing logic (Drug × Payer × Benefit Type)
  • Drive resolution of denials, stalled cases, and payer-related issues
  • Ensure seamless coordination between providers, payers, pharmacies, and internal teams
  • Build SOPs for prescription tracking, routing, and escalation workflows
  • Use data to identify bottlenecks and improve operational performance

What We're Looking For

  • Experience in U.S. healthcare operations, including:
  • Prior Authorization
  • Insurance Coordination
  • Specialty Pharmacy
  • Dispensing Operations
  • Proven ability to manage complex, multi-step workflows across stakeholders
  • Strong ownership mindset with high accountability and follow-through
  • Experience working with EMRs, pharmacy systems, and operational trackers
  • Ability to operate independently in fast-moving, ambiguous environments
  • Strong problem-solving and process optimization skills

Nice to Have

  • Experience with biologics, infusion therapies, or rheumatology
  • Strong understanding of U.S. payer systems and specialty pharmacy dynamics
  • Experience building operational dashboards, tracking systems, or workflow automation

Success Metrics

  • Zero prescriptions lost or untracked in the pipeline
  • Reduced time from prescription to treatment initiation
  • Increased internal dispensing and reduced external leakage
  • Clear, consistent pipeline reporting and operational visibility
  • Scalable SOPs replacing manual or inconsistent workflows

More Info

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About Company

Job ID: 147143389

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