Regional Team Lead - Prior Authorizations - Certified Specialty Pharmacy Te at Shields Health Solutions

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Full Time

Start Date

Immediate

Expiry Date

22 Jun, 26

Salary

0.0

Posted On

24 Mar, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Leadership, Patient Advocacy, Prior Authorizations, Mentoring, Benefit Investigations, Troubleshooting, Claim Issues, Documentation, Payer Requirements, Escalations, Workflow Management, Compliance, Auditing, KPI Monitoring, Change Management, Coaching

Industry

Hospitals and Health Care

Description

Job Purpose: This role blends leadership and patient advocacy responsibilities, supporting the supervisor in ensuring the team has the tools and guidance needed to succeed while maintaining direct patient care responsibilities. Additional context to attract candidates: This position is ideal for an experienced Pharmacy Technician who is passionate about patient access, enjoys mentoring others, and is seeking a pathway into leadership within specialty pharmacy or patient services operations. Job Duties: Patient Advocacy & Clinical Support Maintain direct patient support responsibilities including benefit investigations, prior authorizations and financial assistance programs. Troubleshoot insurance rejections and claim issues. Communicate professionally with patients, clinicians, and payors. Demonstrate clear and concise documentation practices to ensure accurate, timely, and compliant record-keeping across patient interactions and workflow processes. Additional responsibilities include: Serve as a subject matter resource for complex payer requirements, prior authorization escalations, and specialty medication access challenges. Proactively identify barriers to therapy initiation or continuation and partner with clinics and internal teams to resolve issues efficiently. Support adherence and continuity of care by ensuring timely follow-up, status updates, and patient education as appropriate. Maintain strong knowledge of specialty pharmacy workflows, reimbursement processes, and payer trends impacting patient access. Team Leadership & Support Assist the supervisor in monitoring daily team activities and work queues. Provide mentorship and stabilization support for new hires. Share and educate team members on workflow best practices and system navigation. Support clinic growth and stabilization efforts across therapeutic areas. Provide coverage for clinics with staffing gaps or PTO needs. Manage overflow work needs of supported clinics Lead by example, fostering a collaborative and positive team culture Build strong relationships with internal teams, clinic partners, and cross-functional teams. Actively participate in team meetings, training sessions, and knowledge-sharing forums. Additional responsibilities include: Act as a point-of-contact for real-time workflow questions, prioritization guidance, and issue resolution during daily operations. Assist with onboarding activities, shadowing, and continued development of new and existing team members. Reinforce quality, productivity, and compliance standards through coaching and constructive feedback. Promote accountability, engagement, and teamwork while supporting a high-volume, patient-centered environment. Support change management initiatives by helping teams adapt to new systems, payer requirements, and operational enhancements. Operational Excellence Perform audits to ensure workflow adherence and quality standards. Contribute to special projects and process improvement initiatives. Report feedback and insights to supervisors to optimize team performance. Monitor Key Performance Indicators (KPIs), assess gaps in meeting site and organizational goals, and develop targeted action plans to drive continuous improvement. A core responsibility of this role is to ensure the team consistently achieves performance metrics that reflect broader organizational objectives, with a focus on collective outcomes rather than individual contributions. Additional responsibilities include: Identify trends related to turnaround times, authorization approvals, and payer outcomes, and recommend operational improvements. Support documentation and updates to standard operating procedures and workflow guidance. Partner with leadership to pilot new processes, tools, or technologies aimed at improving patient access and team efficiency. Ensure compliance with regulatory, payer, and organizational requirements including HIPAA and industry best practices. Experience / Education: Nationally certified Pharmacy Technician (CPhT via PTCB or ExCPT). Registered or willing to register with the state of employment. 2+ years of experience in specialty pharmacy, patient engagement, or prior authorization. Internal candidates: Minimum 6 months in the Patient Support Center. Proven track record of exceeding performance expectations and service levels. Preferred qualifications to strengthen candidate interest: Experience supporting specialty medications across high-touch therapeutic areas. Demonstrated ability to balance direct patient support with leadership and operational responsibilities. Strong communication, problem-solving, and organizational skills in a fast-paced healthcare environment. Comfort working with pharmacy systems, electronic medical records, payer portals, and workflow management tools. California residents employed by or applying for work at Shields have certain privacy rights. Please review our: California Workforce Privacy Notice and Privacy Policy. By providing your mobile number, you agree to receive text messages from Shields Health Solutions related to job opportunities, interview scheduling, and recruiting updates. Message and data rates may apply. You may opt out at any time by replying 'STOP.' Consent is not a condition of employment. Shields Health Solutions provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Responsibilities

This role involves blending leadership support for the supervisor, ensuring the team has necessary guidance, while maintaining direct patient care responsibilities like benefit investigations and prior authorizations. Key duties include serving as a subject matter expert for complex access challenges and assisting in monitoring daily team activities and work queues.