Remote Pharmacy Prior Authorization & Specialty Access Pro

Medcruit; United States; On-site; USD 85,000 - 121,000; Part time

Job summary

Medcruit is seeking an experienced Pharmacy Prior Authorization and Specialty Medication Access Specialist to evaluate AI tools designed to automate PA workflows and ensure timely authorizations for high-cost therapies. The role requires deep knowledge of drug formularies, step therapy, and payer PA criteria.

You will review clinical documentation, coordinate with prescribers, specialty pharmacies, and payers, and annotate AI outputs to support training datasets.

Qualifications

• 5+ years in PA or PBM roles.
• Deep knowledge of specialty drug formularies and payer PA criteria.
• Experience with Medicare Part D and Medicaid PA.
• Excellent English communication

Responsibilities

• Process PA requests for specialty meds across commercial, Medicare Part D, and Medicaid.
• Review clinical docs and criteria to determine necessity.
• Evaluate AI-generated PA recommendations for accuracy.
• Coordinate with prescribers, specialty pharmacies, and payers.
• Manage appeals and exception processes.
• Navigate formularies, step therapy, and coverage policies.
• Track status and denial trends for process improvements.
• Ensure CMS Part D compliance.

Skills

Pharmacy PBM

Prior authorization

English communication

Attention to detail

AI evaluation

Education

CPhT or CPAP

Tools

Specialty pharmacy platforms

PBM systems

Job description

Medcruit is seeking an experienced Pharmacy Prior Authorization and Specialty Medication Access Specialist to evaluate AI tools designed to automate PA workflows and ensure timely authorizations for high-cost therapies. The role requires deep knowledge of drug formularies, step therapy, and payer PA criteria.

You will review clinical documentation, coordinate with prescribers, specialty pharmacies, and payers, and annotate AI outputs to support training datasets.