Remote | Specialty Medication Prior Authorization Consultant — Up to $55/hour

24-Mag•New York, NY

12h•$45 - $55•Remote

About The Position

We are sharing a specialised part-time consulting opportunity for United States-based pharmacy and healthcare access professionals experienced in pharmacy prior authorization, specialty medication access, payer coverage criteria, step therapy requirements, Medicare Part D coverage determinations, pharmacy benefit management, and patient access workflows. This role supports current and upcoming remote consulting opportunities focused on AI-assisted pharmacy prior authorization evaluation, specialty medication access review, payer criteria assessment, and high-quality project execution. Selected professionals will apply pharmacy access expertise to evaluate AI-generated prior authorization recommendations, review clinical documentation support, identify payer compliance issues, and provide structured feedback based on detailed project criteria.

Requirements

5+ years of experience in pharmacy prior authorization, specialty medication access, pharmacy benefit management, medication access operations, or related healthcare access workflows
Deep knowledge of specialty drug formularies, step therapy protocols, payer prior authorization criteria, and coverage requirements across commercial and government payers
Experience with specialty pharmacy platforms, pharmacy benefit management systems, and medication access workflows
Familiarity with Medicare Part D coverage determination and exception processes
Strong ability to review clinical documentation and determine whether payer authorization requirements are met
Exceptional written and verbal English communication skills
High attention to detail and ability to evaluate clinical documentation, payer criteria, and AI-generated pharmacy outputs
Ability to work independently in a remote, project-based environment
Professional background in pharmacy prior authorization, specialty pharmacy, pharmacy benefit management, medication access, patient access, infusion services, hub services, or payer authorization workflows is highly relevant
Formal education or training in pharmacy, healthcare administration, health information management, nursing, life sciences, or a related healthcare field may be relevant depending on project scope

Nice To Haves

Certified Pharmacy Technician, CPhT, Certified Prior Authorization Professional, CPAP, or similar pharmacy access credential
Experience with hub services, manufacturer assistance programs, copay assistance, and patient access programs for specialty medications
Background in oncology, rheumatology, infusion therapy, biologics, specialty drug access, or high-cost pharmaceutical authorization
Familiarity with AI tools and comfort evaluating AI-generated pharmacy authorization or medication access content
Experience managing authorization status tracking, approval rates, denial trends, appeals, and process improvement workflows
Experience in specialty pharmacy, health systems, provider groups, payer environments, PBM operations, oncology access, rheumatology access, or high-cost medication workflows may be especially valuable
Practical experience with pharmacy authorization platforms, PBM systems, payer portals, clinical documentation review, and medication access processes may support project fit

Responsibilities

Review prior authorization workflows for specialty medications, biologics, and high-cost pharmaceuticals
Evaluate AI-generated pharmacy prior authorization recommendations for accuracy, completeness, and payer compliance
Assess clinical documentation and pharmacy benefit criteria to determine whether medical necessity and coverage requirements are appropriately supported
Identify missing documentation, incomplete payer logic, incorrect coverage assumptions, or weak authorization recommendations
Review specialty drug access workflows across commercial, Medicare Part D, and Medicaid payer environments
Evaluate outputs involving drug formularies, step therapy protocols, exception requests, coverage determinations, and payer-specific prior authorization criteria
Assess coordination workflows involving prescribers, specialty pharmacies, payers, hub services, and patient assistance programs
Review denied authorization scenarios, appeal pathways, peer-to-peer requests, and exception processes where relevant
Annotate AI-generated pharmacy authorization outputs and provide structured feedback to support quality improvement
Explain review decisions clearly, consistently, and with strong pharmacy access judgment
Evaluate outputs for alignment with payer-specific pharmacy benefit requirements, CMS Part D guidelines, and specialty medication access workflows
Follow detailed task instructions, quality criteria, and project-specific review guidelines accurately