Pharmacy Prior Authorization & Specialty-Medication Access Specialist (Train AI Models Part Time!)
Core
Evaluate AI-generated pharmacy prior authorization recommendations and annotate outputs to train AI models for automating pharmacy benefit management workflows.
Role type
Senior IC pharmacy prior authorization specialist (AI training)
Builds
AI systems for automating pharmacy benefit management and specialty drug authorization
Domain
Healthcare / Pharmacy Benefit Management / AI Research
Deliverable
production ML models
Required skills
specialty medication access, payer PA criteria, drug formularies, step therapy, clinical documentation review, appeals management, payer compliance, Medicare Part D guidelines
Preferred skills
Certified Pharmacy Technician (CPhT), Certified Prior Authorization Professional (CPAP), specialty pharmacy platforms, oncology/rheumatology drug access, patient assistance programs, AI tool evaluation
Technologies
specialty pharmacy platforms, pharmacy benefit management (PBM) systems, AI tools
Responsibilities
Process and manage prior authorization requests for specialty medications, biologics, and high-cost pharmaceuticals; Review clinical documentation and pharmacy benefit criteria to determine medical necessity; Evaluate AI-generated pharmacy prior authorization recommendations for accuracy and compliance; Coordinate with prescribers, specialty pharmacies, and payers; Manage appeals for denied authorizations; Navigate payer formularies and step therapy requirements; Track authorization status and denial trends; Ensure compliance with CMS Part D guidelines; Annotate AI outputs and provide structured feedback.
Seniority
Senior, hands-on IC
