Pharmacy Prior Authorization & Specialty-Medication Access Specialist

Help improve AI systems that support pharmacy benefit management and specialty-drug authorization workflows. In this remote, hourly role, you will apply your expertise in formularies, step therapy, payer criteria, and specialty-medication access to evaluate AI-generated recommendations and strengthen patient access to critical therapies. Key Responsibilities

• Process and manage prior authorization requests for specialty medications, biologics, and high-cost drugs across commercial, Medicare Part D, and Medicaid plans.
• Review clinical documentation and pharmacy-benefit criteria to assess medical necessity for specialty-drug authorizations.
• Evaluate AI-generated prior authorization recommendations for accuracy, completeness, and compliance with payer requirements.
• Coordinate with prescribers, specialty pharmacies, and payers to secure timely medication authorizations.
• Manage denied-authorization appeals, including peer-to-peer requests and exception processes.
• Navigate payer formularies, step-therapy requirements, and specialty-drug coverage policies.
• Track authorization status, approval rates, and denial patterns to identify process-improvement opportunities.
• Maintain compliance with payer-specific pharmacy-benefit requirements and CMS Part D guidelines.
• Annotate AI outputs and provide structured feedback that supports AI training datasets.

• At least 5 years of experience in pharmacy prior authorization, specialty-medication access, or pharmacy benefit management.
• Strong knowledge of specialty-drug formularies, step-therapy protocols, and payer prior authorization criteria across commercial and government payers.
• Experience using specialty-pharmacy platforms and pharmacy benefit management systems.
• Familiarity with Medicare Part D coverage determinations and exception processes.
• Exceptional written and verbal English communication skills.
• Close attention to detail and the ability to assess clinical documentation and AI-generated outputs.

• Certified Pharmacy Technician or Certified Prior Authorization Professional credential.
• Experience with hub services and patient-assistance programs for specialty medications.
• Experience in specialty pharmacy, infusion services, or oncology or rheumatology drug access.
• Comfort using AI tools and reviewing AI-generated pharmacy content.
• Experience with manufacturer copay assistance and patient-access programs.

• Remote, hourly engagement.

• $75 per hour.

• Contribute to advanced healthcare AI workflows, collaborate with an AI research organization, and help shape technology used in healthcare revenue-cycle management and medication access.