Specialty Pharmacy Utilization & Authorization Specialist

Socket.dev; Indianapolis (IN); On-site; USD 60,000 - 80,000; Full time

Job summary

The Indiana Hemophilia and Thrombosis Center (IHTC) is seeking an Utilization Review Specialist to manage prior authorizations, medical necessity reviews, and payer requirements for specialty medications. This role partners with prescribers, nurses, pharmacists, and payers to secure timely access while ensuring compliance with insurance guidelines and regulatory standards.

You will gather and validate clinical documentation, initiate and track authorization requests, monitor statuses, and help

Qualifications

• Experience with utilization review and prior authorization for specialty medications.
• Knowledge of payer guidelines, medical necessity criteria, and formulary requirements.
• Strong communication and documentation skills for clinical reviews.

Responsibilities

• Manage prior authorizations and medical necessity reviews for specialty meds.
• Collaborate with prescribers, pharmacists, clinic staff, and payers to obtain required information.
• Submit and track authorization requests through portals, fax, or phone.
• Review clinical documentation to support authorization requests and appeals.
• Maintain accurate records in EHR and pharmacy systems and monitor renewal needs.
• Communicate determinations and timelines to care teams and patients.

Skills

Utilization review

Prior authorization

Medical terminology

EHR systems

Education

High school diploma or GED

Job description

The Indiana Hemophilia and Thrombosis Center (IHTC) is seeking an Utilization Review Specialist to manage prior authorizations, medical necessity reviews, and payer requirements for specialty medications. This role partners with prescribers, nurses, pharmacists, and payers to secure timely access while ensuring compliance with insurance guidelines and regulatory standards.

You will gather and validate clinical documentation, initiate and track authorization requests, monitor statuses, and help