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

Specialised Part-Time Consulting Opportunity

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.

Professionals in this role may contribute to:

• 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

Strong candidates may have:

• 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

• 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
• 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

• 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

• Apply pharmacy prior…