Full-Time
Team Lead Prior Authorization
Posted on 10/31/2025
Free Market Health
51-200 employees
Cloud-based marketplace for specialty pharmacy referrals
No salary listed
Pittsburgh, PA, USA
In Person
On-site in Pittsburgh; occasional travel within a 25-mile radius to local sites.
 Operations & Logistics (1) |
|---|
- High school diploma required; post-secondary education/degree highly desired
- Nationally recognized Pharmacy Technician Certification required
- 5+ years of specialty pharmacy experience with prior authorization and benefit verification required, including at least 2 years of supervisory, lead, or management experience
- Knowledge of drug nomenclature, medical terminology, insurance navigation, and prior authorization processes
- Strong leadership and people management skills
- Excellent written and verbal communication
- Ability to adapt to new technology quickly
- Strong organizational and problem-solving skills, ability to manage multiple priorities, and a track record of driving team success
- Competencies: Leadership and team development, Independent judgment and decision-making, strong communication and customer service orientation, process improvement mindset, critical thinking and problem-solving
- In person/onsite work in FMH Facility required
- Leadership & Team Management – Directly supervise, coach, and develop a team of 4–5 Prior Authorization Specialists, including assigning and overseeing daily work, managing day to day performance of team and escalating issues to staffing agencies
- Serve as the Subject Matter Expert, providing guidance and handling escalations and complex cases
- Responsible for training and onboarding new teammates
- Engaging technology solutions and third party sites to facilitate case support and progress
- Process Oversight & Improvement– Establish and maintain efficient workflows for benefit verification and prior authorization case handling
- Identify areas for improvement and recommend process changes to leadership
- Prescriber Office & Insurance Collaboration – Engage with offices and oversee communications with prescribers and insurance payers to ensure efficient, professional communication
- Technology & Compliance– Ensure team compliance with internal systems, evolving technologies, and regulatory requirements, including HIPAA and company policies
- Problem Solving, Escalation Management and Complex, Tier 3 Workload – Use discretion and independent judgment to resolve complex or sensitive issues, escalating to senior leadership only when appropriate
Free Market Health runs a cloud-based marketplace platform for the specialty pharmacy ecosystem, connecting payers and specialty pharmacies to streamline the delivery of specialty medications by matching patient referrals with suitable pharmacies. It provides real-time insights and analytics to help optimize resource use and opportunities for all stakeholders. The platform serves as a hub for referral management and reimbursement solutions, centralizing workflows to make the process faster and more transparent. Its goal is to create a more efficient, care-driven marketplace that improves patient access while controlling costs for payers, pharmacies, and patients.
Company Size
51-200
Company Stage
Series B
Total Funding
$35.5M
Headquarters
Pittsburgh, Pennsylvania
Founded
2019
Simplify's Take
What believers are saying
- Manages 200,000+ specialty drug claims annually, growing 400% YoY through payer partnerships.
- Payer clients save $2,000+ per specialty utilizer yearly, exceeding 5% total specialty drug spend reduction.
- Highmark partnership demonstrates 40% reduction in prescription abandonment and $2 per member monthly savings.
What critics are saying
- Amazon Pharmacy's 2023 specialty pharmacy launch directly threatens payer relationships and marketplace model.
- Major pharmacy chain consolidation eliminates network diversity and FMH's negotiating leverage.
- Highmark in-sourcing specialty pharmacy operations removes anchor customer and primary proof point.
What makes Free Market Health unique
- Real-time competitive bidding matches patients to specialty pharmacies based on clinical and financial fit.
- Network of 400+ accredited pharmacies enables payers to escape exclusive long-term contracts.
- AI-powered patient onboarding via Beeline Rx acquisition streamlines prior authorization and fulfillment.
Help us improve and share your feedback! Did you find this helpful?
Benefits
Flexible Work Hours
Growth & Insights and Company News
6 month growth
↓ -1%1 year growth
↑ 0%2 year growth
↑ 1%Free Market Health (FMH) announced today that Mike Einodshofer, an industry veteran with over 28 years of experience in pharmacy benefit management and specialty pharmacy, has joined the company as Chief Growth Officer.
Free Market Health's Director of Clinical Product Strategy Tim Mizak, PharmD, MS, MBA shares his experience at the 2025 PQA Annual Meeting and his take on how these themes relate to the future of specialty pharmacy.
/PRNewswire/ -- Free Market Health (FMH), the definitive technology platform transforming the specialty pharmacy ecosystem, today announced its acquisition of...
Strategic decisions around location, leadership and sustainability are key drivers of business growth.In this month’s Power Moves, sustainability takes center stage — whether through downsizing office space to align with post-pandemic workforce needs or expanding facilities to meet the demand for clean-energy manufacturing.Leadership changes at nonprofit Sustainable Pittsburgh and the announcement of a new power generator manufacturing facility highlight the region’s focus on both economic growth and environmental impact.Read on for more details on these developments after the chart showing the top desired tech skills and corresponding median salaries for the month.Niche to move headquarters closer to Strip District TerminalThe edtech company Niche is set to relocate its headquarters down the street from its current location on Liberty Avenue in the Strip District to the Vision on Fifteenth, a building on Smallman Street near the Strip District Terminal. The move was described by Pat Gruden, a long-time company representative, as part of a strategic decision to downsize following the COVID-19 pandemic. The new facility is about 7,400 square feet smaller but more walkable to neighborhood amenities In March, the company quietly laid off 7% of its total staff, leaving the firm with around 300 total employees. This came after the company made headlines in recent years for large funding raises, including a $35 million Series C funding round in 2020.Sustainable Pittsburgh executive director announces departureSustainable Pittsburgh Executive Director Joylette Portlock announced she will step down from her leadership position at the nonprofit by the end of 2024. Portlock led Sustainable Pittsburgh for six years, overseeing a full organizational rebrand and the launch of a new workplace recognition program that awards designations to companies that meet sustainability criteria. Sustainable Pittsburgh Executive Director Joylette Portluck (Courtesy of Sustainable Pittsburgh) Portlock also worked to establish the Clean Energy Workforce Roundtable in 2021. The initiative gathers key stakeholders to promote equitable workforce development to meet the demand for clean energy workers. The company is responsible for additional groups that work to foster sustainable and equitable economic growth, including the CEOs for Sustainability and the Sustainability Practitioners Network. “I’ve come to understand that leadership, especially on sustainability, may best be understood as neither a sprint, nor a marathon – it’s a relay,” Portlock said in a news release
Using real-time pricing, Pharmacy Match drives affordability for plan sponsors while offering access to the most competitive pharmacy for each memberEAGAN, Minn., June 19, 2024 /PRNewswire/ -- Prime Therapeutics LLC and Magellan Rx Management (Prime/MRx) today launched Pharmacy Match, a technology-enabled specialty pharmacy solution designed to drive competition through an expanded specialty pharmacy network and to lower drug costs for plan sponsors.Specialty drugs remain the fastest-growing area of pharmacy spend, accounting for more than half of the total pharmaceutical market today.1 That share is skyrocketing, driven by price increases and the introduction of new treatments,2 further threatening affordability for stakeholders. The inherent fragmentation and complexity in the specialty pharmacy space exacerbates these issues, hindering patient access to necessary therapies and complicating efforts to manage costs effectively in an evolving market.Pharmacy Match further amplifies Prime/MRx's distinctive conflict-free approach to the prescription drug supply chain model by offering members access to a broader network of quality specialty pharmacies, reducing reliance on any single pharmacy partner and promoting real-time competition. Another distinguishing feature is that Pharmacy Match is complementary to other existing Prime/MRx programs, including IntegratedRx® with a proven industry-leading 95% satisfaction rating."Providing access to rapidly expanding specialty treatments while controlling cost is one of the biggest challenges facing health care today," said Nathan Downhour , senior vice president, pharmacy and care solutions at Prime/MRx. "Pharmacy Match is one example of how we are working to expand access to affordable medications while helping members navigate their specialty journey."Pharmacy Match, powered by Free Market Health's proprietary, cloud-based technology platform, helps members smoothly flow through their specialty journey. To help create a frictionless experience, the real-time referral feature comparison shops the market and helps ensure members' specialty medications are provided by the specialty pharmacy best suited to meet their needs. And to help alleviate uncertainty, Pharmacy Match members who are new to therapy are engaged early to help ensure an uninterrupted journey