Certified Clinical Assistant

Job Summary

Managing end-to-end prescribing and prior authorization operations, the full-time hourly Certified Clinical Assistant will navigate complex Pharmacy Benefit Manager (PBM) criteria, handle member escalations, and ensure timely access to prescribed therapies in a remote setting.

Key responsibilities:

• Prepare and submit clinical prior authorization requests for anti-obesity medications to PBMs and health plans
• Act as a key escalation point to resolve complex coverage inquiries from various teams
• Drive timely issue resolution while adhering to key performance indicators for ticket handling and communication

Required qualifications:

• 3+ years of experience in prior authorizations or PBM navigation within a medical clinic, specialty pharmacy, health plan, or telehealth environment
• Proven track record of leading projects or workflow improvements and mentoring colleagues
• Deep knowledge of prior authorization submission criteria and PBM formulary exception workflows
• Proficiency in electronic health record (EHR) tools and prior authorization platforms
• Able to work standard business hours supporting operational needs Monday through Friday