Clinical Services Consultant

Job Summary

To support Prior Authorization operations, the full-time Clinical Services Consultant will provide administrative assistance, serve as a Subject Matter Expert for Prior Authorization systems, and collaborate with internal and external teams in a remote environment.

Key responsibilities

• Configure and validate criteria documents and fax forms within the Prior Authorization system
• Collaborate with colleagues to identify process improvement opportunities and drive operational efficiencies
• Create and maintain work instructions, assist with training, and provide backend user support for Prior Authorization systems

Required qualifications

• Bachelor's degree in a related field
• 3+ years of Pharmacy Benefit Management (PBM) Prior Authorization experience
• Prior Authorization experience within a PBM environment
• Experience with CAS and/or MedHOK systems
• Project management or training experience related to Prior Authorization systems