Job Description
Orange tree system is seeking a Pharmacist for Prior Authorization (also known as Clinical Authorization Coordinator) with a Pharmacist background for a non-clinical role supporting our prior authorization process. This position combines healthcare expertise with cutting-edge technology and offers a dynamic, innovation-driven environment modeled on US healthcare standards.
Key responsibilities:
Review prior authorization requests for medical services, procedures, and prescriptions.
Apply clinical knowledge and payer guidelines to assess medical necessity.
Ensure compliance with HIPAA and payer-specific requirements.
Coordinate with physicians, pharmacists, and healthcare providers to obtain supporting documentation.
Maintain accurate case records in EHR/EMR systems.
Support appeals and denials management when required.
Leverage AI-based tools to streamline authorization workflows and improve decision-making efficiency.
Requirements:
Background in Pharmacy,...
Key responsibilities:
Review prior authorization requests for medical services, procedures, and prescriptions.
Apply clinical knowledge and payer guidelines to assess medical necessity.
Ensure compliance with HIPAA and payer-specific requirements.
Coordinate with physicians, pharmacists, and healthcare providers to obtain supporting documentation.
Maintain accurate case records in EHR/EMR systems.
Support appeals and denials management when required.
Leverage AI-based tools to streamline authorization workflows and improve decision-making efficiency.
Requirements:
Background in Pharmacy,...
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