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Develop Health

AI-driven medication access and authorization automation

Clinical Product & Operations Lead Pharmacist

PharmacyUpdated on Nov 12
Full-timeRemote in USA

About the Job

Requirements

  • A licensed pharmacist (PharmD) with hands-on prior authorization and benefit verification experience is required.
  • At least 3 years of experience in pharmacy operations, specialty pharmacy, or a payer or pharmacy benefit manager environment is required.
  • Strong working knowledge of prior authorization workflows, payer criteria, formularies, and pharmacy benefit manager structures is required to handle moderate-to-complex cases independently.
  • Written and verbal communication skills, including customer-facing experience explaining clinical concepts clearly, are required.
  • The candidate must be comfortable working cross-functionally with product, engineering, and operations in a fast-paced startup.
  • The candidate must quickly learn how the platform and automation fit into payer and pharmacy benefit manager processes and where the product creates leverage in customer operations.
  • The candidate must quickly learn internal escalation paths and engineering workflows and how to raise issues effectively.
  • The candidate must quickly learn how different payers interpret prior authorization and benefit verification requirements and how those differences affect customer experience.
  • The candidate must quickly learn how the AI generates clinical responses and determinations in order to review them and provide actionable feedback to engineers.

Responsibilities

  • Own customer support for moderate-to-complex prior authorization and benefit verification cases, serving as the primary contact for escalations and providing clinical context, status, and a path to resolution.
  • Apply clinical judgment to navigate payer criteria, formulary requirements, and appeals on cases staff cannot resolve independently.
  • Document workflows, write playbooks and standard operating procedures, and turn one-off fixes into repeatable processes.
  • Represent the customer with product and engineering by surfacing patterns in customer difficulties, flagging errors in AI-generated determinations, and helping prioritize fixes.
  • Work with engineering to improve AI agents' handling of real cases by feeding back difficult prior authorization and benefit verification cases, flagging incorrect determinations, and shaping agent workflows.
  • Manage customer communications through email, calls, and Slack, especially in high-stakes patient situations.
  • Own and maintain the operational playbook for handling complex prior authorization and benefit verification cases internally and for customers as payer rules change.
  • Build and track metrics including resolution time, approval rates, and where automation helps or fails.
  • Translate customer-support observations into product improvements.
  • Design and scale training so new pharmacists and technicians ramp quickly and maintain consistent quality.
  • Help shape pharmacy operations and support as the company expands across payers, pharmacy benefit managers, and enterprise partners.
  • Partner with engineering to identify complex casework to automate, determine where human review remains necessary, and maintain quality as AI agents take on more work.

Desired Qualifications

  • Experience building quality assurance processes or supervising pharmacists and technicians.
  • Deep understanding of the patient access journey from prescription to dispensing, including common failure modes and payer friction.
  • Comfort using AI tools to work more efficiently.

About the Company

Develop Health

AI-driven medication access and authorization automation

Develop Health builds AI-powered software that streamlines medication access for healthcare providers and patients. Its core product is an AI-driven platform that automates the prior authorization process. It includes a Benefit Verification tool that processes patient insurance card images and a Clinical Eligibility tool that autofills clinical information, reducing form completion time by over 80%. The platform helps clinicians and staff cut administrative workload and speed up medication access workflows. Unlike generic automation vendors, Develop Health concentrates on the medication authorization and eligibility workflow in healthcare settings, delivering targeted automation for insurance verification, prior authorization, and clinical data entry. The company’s goal is to improve efficiency in medication access and reduce administrative burden for healthcare organizations.

Company size
11-50
Company stage
Series A
Total funding
$16.1M
Headquarters
Menlo Park, CA
Founded
2022

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