Clinical Criteria Coordinator

Job Summary

To support the prior authorization process, the fully remote Clinical Criteria Coordinator will draft, gain approval for, and maintain clinical criteria and question sets, ensuring compliance and accuracy throughout the workflow.

Key responsibilities

• Draft and perform quality checks on clinical criteria policies for medications requiring prior authorization
• Build and deploy approved criteria in the prior authorization platform, ensuring proper testing and version control
• Communicate new and updated criteria to the Prior Authorization Coordinator Team and other internal stakeholders

Required qualifications

• High school diploma required; two-year degree preferred
• Pharmacy technician experience strongly preferred
• Experience with pharmacy prior authorizations or clinical criteria drafting preferred
• Strong research skills and ability to interpret FDA labeling and clinical guidelines
• Proficiency in Microsoft Office 365 and familiarity with Confluence or similar tools