Specialty Pharmacy AI Evaluation Specialist

mpathic; United States; À distance; USD 83 000 - 124 000; Plein temps

Résumé du poste

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.

Responsabilités

• 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.

Connaissances

Pharmacy prior authorization

Specialty medication access

Payer policies

Clinical documentation review

English communication

Attention to detail

AI output evaluation

Description du poste

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