Experienced Pharmacy PA Specialist for AI-Driven Access

Mercor; San Francisco (CA); On-site; USD 120,000 - 180,000; Full time

Job summary

Mercor is collaborating with a leading AI research lab to enhance AI systems for healthcare. We are seeking experienced Medication and Pharmacy Prior Authorisation specialists with expertise in speciality medication access to evaluate AI tools designed to automate pharmacy benefit management and authorisation workflows.

Your deep knowledge of drug formularies, step therapy, and payer PA criteria will directly shape AI systems that improve patient access to critical therapies.

Qualifications

• 5+ years of experience in pharmacy prior authorisation, speciality medication access, or pharmacy benefit management.
• Deep knowledge of speciality drug formularies, step therapy protocols, and payer PA criteria.
• Experience with speciality pharmacy platforms and PBM systems.
• Familiarity with Medicare Part D coverage determination and exception processes.
• Exceptional written and verbal English communication skills.
• High attention to detail with the ability to evaluate clinical documentation and AI-generated outputs.

Responsibilities

• Process and manage prior authorisation requests for speciality medications, biologics, and high-cost pharmaceuticals across commercial, Medicare Part D, and Medicaid payers.
• Review clinical documentation and pharmacy benefit criteria to determine medical necessity for speciality drug authorisations.
• Evaluate AI-generated pharmacy prior authorisation recommendations for accuracy, completeness, and payer compliance.
• Coordinate with prescribers, speciality pharmacies, and payers to obtain timely medication authorisations.
• Manage appeals for denied pharmacy authorisations, including peer-to-peer requests and exception processes.
• Navigate payer formulary, step therapy requirements, and speciality drug coverage policies.
• Track authorisation status, approval rates, and denial trends to identify process improvement opportunities.
• Ensure compliance with payer-specific pharmacy benefit requirements and CMS Part D guidelines.
• Annotate AI outputs and provide structured feedback to support AI training datasets.

Skills

Pharmacy prior authorization

Speciality medication access

Payer PA criteria

English communication

Attention to detail

Tools

PBM systems

Speciality pharmacy platforms

Job description

Mercor is collaborating with a leading AI research lab to enhance AI systems for healthcare. We are seeking experienced Medication and Pharmacy Prior Authorisation specialists with expertise in speciality medication access to evaluate AI tools designed to automate pharmacy benefit management and authorisation workflows.

Your deep knowledge of drug formularies, step therapy, and payer PA criteria will directly shape AI systems that improve patient access to critical therapies.