Clinical Authorization Specialist – PBM & Prior Auth

Vida Health; United States; On-site; USD 49,000 - 59,000; Full time

Job summary

Vida Health seeks a proactive Clinical Assistant to manage end-to-end prescribing and prior authorization workflows for anti-obesity therapies. You will navigate PBM criteria, handle escalations across Medical Providers and Member Services, and ensure timely access to prescribed therapies.

The role emphasizes autonomy, mentoring peers, and cross-team collaboration. The position is full-time in the US with a 3-month seasonal term and potential extensions based on performance.

Qualifications

• 3+ years of experience focused on prior authorizations or PBM navigation in medical settings.
• Proven initiative, project leadership, and ability to mentor colleagues without direct reports.
• Deep knowledge of PA submission criteria, formulary workflows, and cardiometabolic drugs.
• Excellent written and verbal communication; can resolve escalations diplomatically.
• Proficiency with EHR tools and PA platforms; comfortable with cloud collaboration tools.

Responsibilities

• Prepare, review, and submit accurate PA requests to PBMs and health plans.
• Autonomously manage complex exception processes and formulary overrides.
• Serve as escalation point to resolve complex coverage inquiries.
• Train teammates on PA guidelines and assist with PBM formulary details.
• Review provider messages, triage, and drive timely issue resolution.
• Document all hours worked using ADP pay codes and adhere to QA guidelines.

Skills

Prior authorizations navigation

PBM workflows

Leadership / mentoring

Cross-department escalation

EHR proficiency

Communication

Independent work

Time management

Education

Certified Medical Assistant (CMA)

Tools

CoverMyMeds

Google Suite

Slack

PBM/Pharmacy systems

Job description

Vida Health seeks a proactive Clinical Assistant to manage end-to-end prescribing and prior authorization workflows for anti-obesity therapies. You will navigate PBM criteria, handle escalations across Medical Providers and Member Services, and ensure timely access to prescribed therapies.

The role emphasizes autonomy, mentoring peers, and cross-team collaboration. The position is full-time in the US with a 3-month seasonal term and potential extensions based on performance.