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knownwell is a weight-inclusive healthcare company delivering obesity care through a combination of in-clinic and virtual services, including weight management, primary care, nutrition counseling, and health coaching. Backed by $50M in funding from CVS Health Ventures, a16z Bio + Health, Flare Capital, MassMutual, and Intermountain Ventures, the company is scaling rapidly to expand access to evidence-based obesity care nationwide.
You will lead the Prior Authorization team, owning the end-to-end process of securing insurance approval for patients' obesity management medications and prescribed treatments. This is a high-visibility operational role where turnaround time and communication directly impact whether patients can start and maintain their care plans.
Key Responsibilities:
- Manage and coach a team of Prior Authorization specialists, including performance management, scheduling, coverage planning, and staffing continuity across in-house and BPO/outsourced resources.
- Own the outsourced staffing vendor relationship, including capacity planning and quality oversight.
- Own Prior Authorization turnaround time, coverage rate, and backlog metrics; build and maintain visibility into team performance for leadership.
- Drive structured status tracking and work-list management in Athena and CoverMyMeds, ensuring every request has clear, current status and ownership.
- Own and evolve Prior Authorization competency frameworks, training materials, and SOPs to handle complex payer requirements (including GLP-1 and obesity management medication authorizations) consistently.
- Partner directly with clinicians on complex cases, exercising independent judgment on escalations and physician relations.
- Identify and fix process or tooling breakdowns (macros, escalation paths, notification workflows) that create patient-facing failures.
- Lead hiring, onboarding, and ramp-up of new Prior Authorization team members.
- Report on Prior Authorization performance and risk to Central Operations leadership, flagging staffing or payer-side issues proactively.
You will report into Central Operations leadership and work cross-functionally with clinicians, Patient Experience Coordinators, and Patient Access teams.
Requirements:
- 5-7 years of prior authorization experience, including 3+ years in a leadership role managing a Prior Authorization or similar insurance-facing operations team.
- Deep working knowledge of the Prior Authorization lifecycle, payer requirements, and tools like CoverMyMeds and an EHR (Athena strongly preferred).
- Experience managing distributed or blended teams (in-house + BPO/outsourced), including vendor management.
- Track record of building process and measuring it; default to structured tracking and metrics rather than tribal knowledge.
- Strong cross-functional communication skills; comfortable being the connective tissue between clinicians, operations, and patients.
- Calm under staffing or volume pressure, with bias toward fixing root causes rather than patching symptoms.
- Familiarity with GLP-1s or obesity management medications and genuine investment in weight-inclusive, patient-centered care is a strong plus.
