Remote Specialty Rx Coordinator: Prior Authorization & Care

Jobgether; United States; Remote; USD 50.000 - 55.000; Vollzeit

Benefits dieser Stelle

Medical Insurance

Dental & Vision

PTO

Tuition Reimbursement

EAP

Tech Stipend

Remote Flexibility

Zusammenfassung

Jobgether in the United States is seeking a seasoned healthcare operations professional to lead prior authorization, specialty medication coordination, single case agreements, and vendor program management.

You will collect records, document requests, coordinate appeals, update member records, and ensure decisions are communicated accurately across retail and specialty pharmacists, prescribers, and members.

Qualifikationen

• Bachelor's degree or equivalent professional work experience.
• At least five years of experience in pharmacy/medical benefits and specialty pharmacy.
• Experience with prior authorization management.
• Familiarity with RA, transplant, Hepatitis C, infectious diseases, or oncology meds is a plus.
• Excellent written and verbal communication; able to coordinate with multiple stakeholders.
• Strong organizational skills and attention to detail.
• Ability to meet deadlines in a fast-paced environment.
• Proficient with Microsoft Office; familiarity with claims or member management systems is beneficial.

Aufgaben

• Manage pharmacy and medical prior authorization requests.
• Coordinate specialty and vendor communications and documentation.
• Negotiate and document single case agreements; update member records.
• Assist members with financial concerns about specialty meds.
• Coordinate referrals with third-party vendors and implement programs.
• Review vendor plan language for regulatory compliance.
• Collaborate across departments to develop vendor-related policies.
• Escalate issues and provide status updates to clients and teams.
• Improve workflows and service delivery among members, facilities, and vendors.
• Perform other duties to support medical management and specialty operations.

Kenntnisse

Prior Authorization

Communication Skills

Organization

Time Management

Analytical Thinking

Adaptability

Technical Proficiency

Ausbildung

Bachelor's degree

Tools

Microsoft Office

QicLink system

Claims systems

Jobbeschreibung

Jobgether in the United States is seeking a seasoned healthcare operations professional to lead prior authorization, specialty medication coordination, single case agreements, and vendor program management.

You will collect records, document requests, coordinate appeals, update member records, and ensure decisions are communicated accurately across retail and specialty pharmacists, prescribers, and members.