Health researchers often seek to leverage pastoral authority in Black churches to forge community partnerships that address racial health disparities in the United States. Yet, researchers have not fully recognized the range (and limits) of pastoral authority as well as the complex role of religion in African American health. Here we explore how health and science are engaged in Black Church contexts and what role pastoral authority plays in this process. Drawing on focus groups with Black pastors and interviews with congregants, we outline three different dimensions of pastoral authority: gatekeeper, connector, and moral exemplar. We argue that these dimensions create tensions between the priestly and prophetic mandates of Black pastors, which in turn impact how church members engage with health resources and scientific knowledge. These results complicate current understandings of how authority functions in Black churches while underscoring the need to seriously consider Black Religion in studies of religion, health, and science.