Pharmacy Prior Authorization & Specialty-Medication Access Specialist | $75/hr Remote
Overview
We are seeking an experienced pharmacy prior authorization and specialty medication access specialist to collaborate with a leading AI research lab. Your deep knowledge of drug formularies, step therapy, and payer criteria will help shape AI systems that automate pharmacy benefit management and specialty drug authorization workflows, ultimately improving patient access to critical therapies. This is a remote, hourly contract role with a competitive rate.
What You'll Do6
- 1Process and manage prior authorization requests for specialty medications, biologics, and high-cost drugs across commercial, Medicare Part D, and Medicaid payers.
- 2Review clinical documentation and pharmacy benefit criteria to determine medical necessity for specialty drug authorizations.
- 3Evaluate AI-generated prior authorization recommendations for accuracy, completeness, and compliance with payer requirements.
- 4Coordinate with prescribers, specialty pharmacies, and payers to secure timely medication approvals and manage appeals, including peer-to-peer reviews and exception processes.
- 5Track authorization status, approval rates, and denial trends to identify opportunities for workflow improvement.
- 6Provide structured feedback on AI outputs to support training datasets and model refinement.
Requirements4
- 15+ years of hands-on experience in pharmacy prior authorization, specialty medication access, or pharmacy benefit management.
- 2Expert knowledge of specialty drug formularies, step therapy protocols, and payer prior authorization criteria across both commercial and government programs.
- 3Familiarity with specialty pharmacy platforms and pharmacy benefit management (PBM) systems, plus experience with Medicare Part D coverage determinations and exceptions.
- 4Excellent written and verbal English communication skills and a high attention to detail for evaluating clinical documentation and AI-generated outputs.
Who Should Apply
This role is perfect for a seasoned pharmacy prior authorization specialist who is not only expert in navigating complex payer requirements for specialty medications but also excited to apply their domain knowledge to improve AI-driven healthcare tools. You should be comfortable providing detailed feedback on automated outputs and working in a fast-paced, remote environment with a top-tier research organization.
Salary Insight
The role pays $75.00 per hour on a contractual basis.
Application Tip
When applying, emphasize your experience handling oncology or rheumatology drug authorizations, and mention any prior work with AI evaluation or data annotation—this will set you apart.
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