Pharmaceutical Expert (Contract)

mpathic; United States; Remote; USD 83,000 - 124,000; Full time

Job summary

mpathic is seeking a contract expert in specialty medication access to review AI-assisted recommendations, assess medical necessity, and ensure payer policy alignment. You will bring real-world PBM experience and strong clinical judgment to annotate model outputs and guide safer, more reliable AI workflows.

The role focuses on evaluating prior authorization decisions, formularies, step therapy, and documentation, with an emphasis on clear feedback to improve AI performance in complex pharmacy

Qualifications

• 5+ years of experience in pharmacy prior authorization, specialty medication access, PBM, or related field.
• Deep understanding of specialty drug formularies, step therapy requirements, and payer authorization criteria.
• Experience with PBM systems or medication access programs; strong written English.

Responsibilities

• Evaluate AI-generated prior authorization recommendations for accuracy, completeness, and alignment with payer requirements.
• Review specialty medication requests using expertise in formularies, step therapy, and payer policies.
• Assess clinical documentation and determine whether AI outputs reflect appropriate medical necessity criteria.
• Apply structured evaluation guidelines to annotate model responses and identify errors, gaps, and opportunities for improvement.
• Provide clear, actionable feedback to improve AI performance on complex pharmacy authorization workflows.
• Assess AI outputs involving coordination with prescribers, specialty pharmacies, and payers during the authorization process.
• Bring real-world knowledge of specialty medication access to shape safer, more trustworthy healthcare AI.

Skills

Pharmacy prior authorization

Specialty medication access

Payer policies

Clinical documentation review

English communication

Attention to detail

AI output evaluation

Job description

About mpathic.ai

mpathic is keeping humans safe in the AI era through automated tools and expert datasets that are rooted in psychology and powered by clinicians.We are a series A start-up backed by Tier 1 investors including Foundry.vc and Next Frontier Capital.

If you have applied for an expert role within the past 12 months, you do not need to reapply.

About the role

Your expertise in specialty medication access, pharmacy benefits, payer policies, and prior authorization will help ensure AI systems produce accurate, clinically sound, and policy-compliant recommendations. You'll review real-world scenarios, evaluate AI-generated outputs, and provide the feedback that helps make these systems more reliable for patients, providers, and care teams.

What You'll Do

• Evaluate AI-generated prior authorization recommendations for accuracy, completeness, and alignment with payer requirements.
• Review specialty medication requests using your expertise in formularies, step therapy protocols, and pharmacy benefit policies.
• Assess supporting clinical documentation and determine whether AI outputs reflect appropriate medical necessity criteria.
• Apply structured evaluation guidelines to annotate model responses and identify errors, gaps, and opportunities for improvement.
• Provide clear, actionable feedback that helps improve AI performance on complex pharmacy authorization workflows.
• Assess AI outputs involving coordination with prescribers, specialty pharmacies, and payers throughout the authorization process.
• Bring real-world knowledge of specialty medication access to help shape safer, more trustworthy healthcare AI.

Qualifications

• 5+ years of experience in pharmacy prior authorization, specialty medication access, pharmacy benefit management, or a closely related field.
• Deep understanding of specialty drug formularies, step therapy requirements, and payer authorization criteria across commercial and government health plans.
• Experience working with specialty pharmacy platforms, pharmacy benefit management (PBM) systems, or medication access programs.
• Strong written English and the ability to communicate complex clinical and policy concepts clearly.
• Exceptional attention to detail and strong judgment when reviewing clinical documentation and AI-generated outputs.

Nice to Have

• Certified Pharmacy Technician (CPhT), Certified Prior Authorization Professional (CPAP), or similar credential.
• Experience supporting specialty pharmacy, infusion services, oncology, rheumatology, or other high-cost therapeutic areas.
• Experience evaluating clinical documentation for payer compliance and medication access decisions.
• Interest in AI and emerging healthcare technologies, including experience reviewing or evaluating AI-generated content.

Compensation

This is a contract, project-based position. The hourly rate will depend on experience and project parameters. The rate will be disclosed prior to starting the project.