CPAP Module 22, Section 3: Building and Managing a Team
MODULE 22: LEADERSHIP & CAREER DEVELOPMENT

Section 3: Building and Managing a Team

The Supervisor as Architect: Designing, Constructing, and Maintaining a High-Performance PA Unit.

SECTION 22.3

Building and Managing a Team

A deep dive into the operational disciplines of hiring, onboarding, performance management, and workforce planning.

22.3.1 The “Why”: From Specialist to Team Architect

You have now embraced the mindset of a supervisor and explored the arts of leadership and mentoring. This section transitions from the “why” and “who” of leadership to the operational “how.” Here, we focus on the tangible, architectural work of building and managing a team. An elite Prior Authorization team does not happen by accident. It is not merely a collection of skilled individuals; it is a carefully designed and constructed entity. As the supervisor, you are the chief architect.

Think of your team as a high-performance engine. Your leadership skills provide the fuel and inspiration, but your management skills are what ensure the engine is built with the right parts, assembled correctly, and maintained to precise specifications. This involves a deliberate, cyclical process: you must design the roles you need, select the right talent to fill them, integrate them seamlessly into the system, set clear performance standards, and continuously fine-tune the entire operation. This is where your strategic vision meets the pavement of daily operations.

This section will provide a masterclass in these core management functions. We will move from theory to application, providing you with the detailed frameworks, checklists, and scripts required to excel at hiring, onboarding, setting expectations, managing workload, and handling the most difficult conversations with confidence and professionalism. Mastering these skills is what separates a well-intentioned leader from a truly effective manager who can build a team that is not only happy and engaged, but also consistently delivers outstanding results.

Pharmacist Analogy: Building a Compounding Pharmacy

Imagine being tasked with building a brand-new, USP-compliant sterile compounding facility from the ground up, attached to your existing retail pharmacy. Your current role is as a staff pharmacist, expertly verifying prescriptions. Your new role is as the Compounding Pharmacy Manager.

Hiring (Designing the Team): You can’t just hire your best retail technician. You need a specific skillset. You write a job description that requires “experience with aseptic technique” and “knowledge of USP <797>.” During the interview, you don’t just ask about their work ethic; you ask behavioral questions like, “Tell me about a time you identified a potential contamination in a clean room. What steps did you take?” You are hiring for a specialized competency, not just a warm body.

Onboarding (Constructing the System): A new hire, even an experienced one, can’t just start compounding. You have a structured, 90-day onboarding plan. Week 1 is learning your pharmacy’s specific policies and the layout of the clean room. Weeks 2-4 involve supervised practice on media-fill tests to validate their aseptic technique. Only after they are fully certified on your equipment and processes do they begin working on patient-specific preparations, and even then, their first 50 batches are subject to 100% verification by you.

Managing Performance (Maintaining the Standard): You don’t just hope for the best. You manage to a clear, non-negotiable standard. You conduct daily checks of the temperature and pressure logs. You perform weekly audits of cleaning records. You have a dashboard that tracks batch turnaround times and error rates. When a technician’s error rate ticks up, you don’t ignore it. You pull them aside, review the process with them, observe their technique, and provide coaching. You have a difficult conversation because the standard of sterile compounding—patient safety—is absolute.

Building and managing a PA team requires the same architectural rigor. You must intentionally design your team, build a robust onboarding system, and relentlessly manage to a high standard of quality and efficiency.

22.3.2 The Foundation: Strategic Hiring and Interviewing

Every supervisor eventually learns a hard truth: you cannot coach your way out of a bad hire. The most effective way to build a great team is to be disciplined and strategic about who you let onto the team in the first place. As a new supervisor, you will be heavily involved in the hiring process, and it is one of your most high-leverage activities. A single great hire can elevate the entire team’s performance, while a poor hire can drain an enormous amount of your time and energy and damage team morale. Your goal is to move beyond the traditional, resume-based interview and adopt a competency-based approach designed to predict future success in the unique environment of PA operations.

Step 1: Define Your “Coordinator Success Profile”

Before you even write a job description, you must define what you are actually looking for. Go beyond vague terms like “hard worker” and “team player.” Create a detailed success profile that breaks down the specific technical and behavioral competencies required for excellence in the role.

Competency Category Specific Competency What It Looks Like in a PA Coordinator Role
Technical Skills Clinical Acumen Ability to read and interpret clinical notes, understand basic disease states, and recognize key clinical data points required for a PA (e.g., lab values, prior treatment failures).
Payer Knowledge Experience navigating various payer portals, understanding formulary structures, and familiarity with the general landscape of major commercial and government payers.
Systems Proficiency Ability to learn and efficiently operate multiple software systems, including the EHR, payer portals, and internal documentation software. Fast and accurate typing skills.
Behavioral Competencies Resilience & Tenacity Maintains a positive and professional demeanor despite facing repetitive denials, frustrating systems, and difficult conversations. Views obstacles as challenges to be overcome, not as reasons to give up.
Problem-Solving Treats each denial as a puzzle to be solved. Methodically analyzes the reason for rejection, reviews available information, and identifies the most effective path to a resolution rather than just escalating.
Attention to Detail Catches small but critical errors in patient demographics, dates of service, or clinical data that could lead to an automatic denial. Submits clean, accurate, and complete applications.
Communication & Empathy Can clearly and concisely communicate with provider offices to obtain needed information. Can also communicate with patients with empathy, explaining complex insurance situations in simple terms.
Time Management Can effectively juggle a large caseload of pending PAs, prioritize urgent requests, and manage a calendar of follow-up dates without letting cases fall through the cracks.
Step 2: The Art of Behavioral Interviewing with the STAR Method

The single best predictor of future performance is past performance in a similar situation. Behavioral interviewing is a structured method designed to uncover that past performance. Instead of asking hypothetical questions (“How would you handle…”), you ask for specific, real-world examples. The framework for answering these questions is the STAR method.

Deconstructing the STAR Method

When you ask a behavioral question, you must listen for all four parts of the STAR answer. If a candidate misses a part, your job is to probe until you get it.

  • Situation: “Describe the specific situation or context. Who was involved? When did this happen?” (This sets the scene).
  • Task: “What was your specific goal or responsibility in that situation? What were you trying to accomplish?” (This defines success).
  • Action: “What specific actions did you take? Walk me through the steps. What did you say? What did you do?” (This is the most important part. Look for “I” statements, not “we”).
  • Result: “What was the outcome? How did your actions specifically affect the result? What did you learn?” (This demonstrates impact and self-awareness).
Masterclass Table: The PA Supervisor’s STAR Interview Question Bank
Competency STAR Interview Question(s) What to Listen For (Green Flags & Red Flags)
Resilience & Tenacity
  • “Tell me about the most frustrating or seemingly impossible PA case you’ve ever had to work on. What made it so difficult?”
  • “Describe a time you received feedback or a quality audit score that you disagreed with. How did you handle it?”
 Green Flags: Describes their emotional response but focuses on the professional process they followed. Takes ownership. Shows persistence over multiple attempts. Can articulate what they learned from the experience.

Red Flags: Blames others (the payer, the doctor, the system). Expresses a sense of hopelessness or victimhood. Cannot describe a structured process for handling the setback.
Problem-Solving
  • “Walk me through a time a PA was denied for a reason you had never seen before. What were the exact steps you took to figure out a solution?”
  • “Tell me about a time you identified a flaw or inefficiency in a workflow. What was it, and what did you do about it?”
 Green Flags: Describes a logical, methodical process. Mentions using resources (policy manuals, colleagues, payer websites). Brainstorms multiple options before acting. Focuses on understanding the root cause of the problem.

Red Flags: Immediately escalated the problem without trying to solve it first. Can’t describe a clear thought process. The solution was just a lucky guess.
Attention to Detail
  • “Describe a time when your attention to detail prevented a significant error or denial. What was the situation and what did you catch?”
  • “Walk me through your personal quality check process before you submit a complex PA.”
 Green Flags: Provides a very specific example (e.g., catching a mismatched diagnosis code, an incorrect date of service). Describes a systematic, personal checklist or review process. Shows pride in accuracy.

Red Flags: Gives a vague, generic answer (“I’m very detail-oriented”). Cannot provide a concrete example. Dismisses the importance of small details.
Communication
  • “Tell me about a time you had to get critical information from a busy or unresponsive doctor’s office. What was your strategy?”
  • “Describe a situation where you had to explain a complex denial to a frustrated patient or family member. How did you approach it?”
 Green Flags: Demonstrates empathy and perspective-taking. Describes building rapport (“I started by asking the nurse what the best time to call was”). Tailors their communication style to the audience. Remains professional under pressure.

Red Flags: Expresses frustration with the doctor’s office. Uses technical jargon when describing a patient conversation. Lacks empathy.

22.3.3 The Critical First 100 Days: Architecting a World-Class Onboarding Experience

You have successfully hired a promising new coordinator. The next 100 days are arguably the most critical period in their entire tenure with your company. A well-designed onboarding program will accelerate their journey to full productivity, integrate them into your team’s culture, and significantly increase their long-term engagement and retention. A poor onboarding experience—often a “sink or swim” approach where the new hire is given a login and a pile of cases—is a leading cause of early employee turnover and perpetuates inconsistent quality and performance.

Onboarding is not a one-day orientation. It is a structured, multi-phase process designed to build competence and confidence in layers. Your goal is to create a program that moves the new hire systematically from foundational knowledge to independent practice.

The High Cost of “Sink or Swim” Onboarding

Many organizations underinvest in onboarding, thinking it’s faster to just throw a new person into the work. This is a costly mistake. The consequences include:

  • High Early Turnover: Overwhelmed and unsupported new hires are far more likely to quit within the first 6 months, forcing you to start the expensive hiring process all over again.
  • Inconsistent Quality: Without structured training, new hires develop bad habits and inconsistent workflows, leading to errors that impact patients and require rework from the rest of the team.
  • Low Morale: The stress of being unprepared damages the new hire’s confidence. It also frustrates senior team members who are constantly interrupted with basic questions that should have been covered in training.

A structured onboarding plan is an investment that pays massive dividends in team stability, quality, and morale.

Masterclass Table: The 90-Day PA Coordinator Onboarding Plan
Phase & Timeline Theme Key Activities & Goals Supervisor’s Role
Phase 1: Orientation & Integration (Week 1) “Welcome to the Team. Here’s Why We Matter.”
  • Goal: Make the new hire feel welcome, connected, and purposeful. No productivity expectations.
  • Complete HR paperwork, get system access.
  • Formal introductions to every team member.
  • Assign a “Buddy” (a senior peer, not the supervisor).
  • Shadow different team members to observe various workflows.
  • Review the team’s mission and its role in patient care.
  • Provide a tour and explain the logistics of the workplace.
 Set a positive tone. Facilitate introductions. Have a welcome lunch. Conduct a 1:1 to set expectations for the onboarding process and answer initial questions. Ensure the “Buddy” is prepared.
Phase 2: Foundational Training (Weeks 2-4) “Learning the Ropes in a Safe Environment.”
  • Goal: Build core knowledge of systems, major payers, and common workflows.
  • Structured, classroom-style training on EHR, documentation software, and key payer portals.
  • Assign a “training queue” of non-urgent, historical cases to practice the workflow.
  • 100% Quality Assurance: You or a senior delegate reviews every single training case the new hire completes, providing immediate, constructive feedback.
  • Introduce them to the centralized knowledge base.
 Lead or oversee the training sessions. Conduct daily check-ins (15 mins) to answer questions and review progress. Provide detailed, encouraging feedback on their practice work.
Phase 3: Building Competence (Month 2) “From the Simulator to the Real World.”
  • Goal: Begin applying skills to live cases with a strong safety net.
  • Assign a limited, live caseload (e.g., 25-50% of a full workload), focusing on one or two specific payers or drug types.
  • Reduce QA to 50%, but focus the reviews on more complex aspects of the case.
  • Encourage reliance on the “Buddy” for day-to-day questions.
  • Weekly 1:1s shift to reviewing live case examples and coaching on problem-solving.
 Monitor workload to prevent overwhelm. Provide specific coaching using the GROW model. Give the “Buddy” feedback on their mentoring. Start introducing performance metrics as a teaching tool, not a judgment.
Phase 4: Building Independence (Month 3) “Taking Ownership.”
  • Goal: Transition the new hire to function as a fully integrated team member.
  • Gradually increase caseload to 75-100% of the team standard.
  • Reduce QA to the standard team level (e.g., 10-15%).
  • Set formal, initial performance goals for productivity and quality.
  • Encourage participation in team problem-solving meetings.
  • Conduct a formal 90-day performance review to celebrate progress and set goals for the next quarter.
 Shift from constant teaching to periodic coaching. Focus 1:1s on career interests and development goals. Formally recognize their “graduation” from the onboarding program in a team meeting to boost their confidence.

22.3.4 Setting the Standard: Proactive Performance Management

Performance management is not an annual review. It is the continuous, daily process of setting clear expectations, monitoring performance, and providing coaching and feedback to help your team members succeed. A proactive approach to performance management is fair, transparent, and motivating. A reactive approach, where you only address performance when it becomes a major problem, feels punitive and creates anxiety. Your goal as a manager is to create a culture where every team member knows exactly what success looks like and where they stand relative to that standard at all times.

The Trinity of Performance Metrics: Quality, Productivity, and Behavior

A balanced performance management system rests on three pillars. Over-indexing on one at the expense of the others leads to a dysfunctional team. For example, focusing only on productivity can lead to poor quality and burnout. Focusing only on quality can lead to missed deadlines. You must manage all three.

1. Productivity (The “How Much”)

This measures efficiency and output. It’s the most straightforward to track.

  • Key Metrics: Cases processed per day/week, Average Turnaround Time (TAT).
  • Goal Setting: Goals should be realistic, based on historical data, and tiered (e.g., “Meets,” “Exceeds”).
  • Management Tip: Use productivity data to identify potential process bottlenecks or training needs, not as a weapon.

2. Quality (The “How Well”)

This measures accuracy and adherence to standards. It is the foundation of patient safety and financial performance.

  • Key Metrics: Quality Assurance (QA) score from peer or supervisor review, Denial Rate (controllable denials).
  • Goal Setting: The quality standard should be high and non-negotiable (e.g., 95-98% accuracy).
  • Management Tip: Frame QA reviews as coaching tools. For every audit, provide specific, actionable feedback on what was done well and what could be improved.

3. Behavior (The “How”)

This measures professionalism, teamwork, and cultural contribution. It’s the hardest to quantify but is critical for a healthy team.

  • Key Metrics: Adherence to attendance policies, collaboration with teammates, professionalism in communication.
  • Goal Setting: Set clear behavioral expectations in your team charter or code of conduct.
  • Management Tip: Address negative behaviors immediately and privately, using specific, observable examples. Recognize and reward positive behaviors publicly.

22.3.5 The Toughest Job: Handling Difficult Conversations

No supervisor enjoys difficult conversations, whether it’s addressing poor performance, negative behavior, or attendance issues. The natural human instinct is to avoid conflict. However, your willingness to handle these situations promptly, professionally, and empathetically is a defining characteristic of an effective leader. Avoiding these conversations is an abdication of your responsibility. It is unfair to the individual who is failing (as they are not being given a chance to improve), it is unfair to the rest of the team who has to pick up the slack, and it ultimately undermines your credibility as a leader.

The key to success is preparation and structure. A difficult conversation should never be an emotional, off-the-cuff reaction. It should be a planned, objective, and supportive interaction with a clear goal: to improve performance or behavior.

Your HR Partner is Your Co-Pilot

Before any formal disciplinary conversation (especially one that could lead to a Performance Improvement Plan or termination), you must consult with your Human Resources partner. HR is not there to be a roadblock; they are there to be your expert guide. They will ensure that you are following company policy, that your documentation is sound, and that you are handling the situation in a way that is fair, consistent, and legally defensible. Never go it alone on serious personnel issues.

Masterclass Scripting: A Framework for Underperformance Conversations

This five-part framework provides a roadmap for a constructive conversation about performance gaps. It moves from objective facts to collaborative problem-solving.

The Feedback Framework in Action

Scenario: An employee, David, has consistently missed his productivity target for the last three weeks, and his quality scores have dipped.

  1. State Your Observation (The “What”): Start with a clear, objective, data-based statement. Avoid judgmental language.
    • Don’t Say: “David, you’ve been slacking off lately.” (Judgmental)
    • Do Say: “David, I wanted to chat about your performance over the last few weeks. I’ve noticed in our weekly reports that your case closure rate has been around 15 cases per day, while the team goal is 25. I also saw in your last two quality audits that your score was 85%, below our team standard of 95%.” (Factual and specific)
  2. Share the Impact (The “So What”): Explain why this matters. Connect it to the team, the patient, or the department’s goals.
    • Do Say: “The impact of this is twofold. First, it means that other team members have had to absorb some of your caseload, which puts a strain on everyone. More importantly, the quality errors I saw, like the incorrect dates of service, can cause automatic denials that delay patient care.”
  3. Pause and Ask for Their Perspective (The Inquiry): This is the most critical step. After stating the facts and impact, you must pause and listen. The goal is to understand their story.
    • Do Say: “That’s what I’m seeing from my side. Can you walk me through your perspective? What’s been going on?” (Then, be silent and actively listen).
  4. Collaborate on a Solution (The “Now What”): Based on their response, work together to build a plan. If it’s a skill gap, the solution is training. If it’s a motivation issue, it might be a need for clearer goals or more recognition. If it’s a personal issue, it might involve HR or EAP.
    • Do Say: “Okay, thank you for sharing that. It sounds like you’re feeling overwhelmed with the new criteria for the immunology drugs. I agree, they are complex. How about this: for the next two weeks, let’s pair you with Sarah, our SME, for an hour each day to review those cases. I also want you to complete the online training module by next Friday. How does that sound as a starting point?”
  5. Set a Follow-Up (The Commitment): Agree on a specific time to check in on the plan. This creates accountability.
    • Do Say: “Excellent. Let’s meet again next Friday at 10 AM to review your progress and see how the plan is working. My goal is to get you back on track and feeling confident. I’m here to support you.”