Job Description
Orange Tree System (OTS) is seeking a motivated Pharmacist for a Prior Authorization Specialist role (also known as Clinical Authorization Coordinator. This is a non-clinical healthcare role ideal for professionals who want to combine clinical knowledge, insurance workflows, and healthcare technology within a U.S.-style healthcare environment.
This role supports prior authorization, utilization management, medical necessity review, and payer compliance processes while leveraging AI-powered healthcare tools to improve efficiency and accuracy.
PharmD students and fresh graduates are encouraged to apply.
Key Responsibilities:
Review and process prior authorization requests for medical services, procedures, and prescription medications
Apply clinical judgment, evidence-based guidelines, and payer policies to determine medical necessity
Ensure compliance with HIPAA, CMS, and payer-specific authorization standards
Collaborate with physicians, pharmacists, nurses, and hea...
This role supports prior authorization, utilization management, medical necessity review, and payer compliance processes while leveraging AI-powered healthcare tools to improve efficiency and accuracy.
PharmD students and fresh graduates are encouraged to apply.
Key Responsibilities:
Review and process prior authorization requests for medical services, procedures, and prescription medications
Apply clinical judgment, evidence-based guidelines, and payer policies to determine medical necessity
Ensure compliance with HIPAA, CMS, and payer-specific authorization standards
Collaborate with physicians, pharmacists, nurses, and hea...
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