Pharmacy Prior Authorization and Specialty Medication Access Specialist

Help improve AI tools that support pharmacy benefit management and specialty-medication authorization workflows. In this remote, hourly role, you will apply your expertise in formularies, step therapy, payer prior-authorization criteria, and medication access to assess AI-generated recommendations and support 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 determine medical necessity for specialty-drug authorizations.
• Evaluate AI-generated prior-authorization recommendations for accuracy, completeness, and payer compliance.
• 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 trends 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 for AI training datasets.

• At least 5 years of experience in pharmacy prior authorization, specialty-medication access, or pharmacy benefit management.
• Deep 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-determination and exception processes.
• Exceptional written and verbal English communication skills.
• Strong 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.
• Background in specialty pharmacy, infusion services, or oncology or rheumatology drug access.
• Comfort using AI tools and evaluating 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, including pharmacy benefit management and healthcare revenue-cycle work, while helping shape tools intended to improve access to therapy.