Prior Authorization Clinical Criteria & Policy Coordinator

TrueScripts Management Services is a pharmacist-founded, fully transparent Prescription Benefit Manager that has been revolutionizing the PBM industry since 2014. Our mission is to build lasting relationships by providing prescription benefit expertise at a personal and customized level to ensure optimum value at the lowest possible cost. We are committed to lowering prescription drug spending, achieving clinically effective outcomes, and always delivering Amazing Care.

Did we mention Amazing Care? Good! Because this is so much more than just our tagline. It is the foundation upon which our business was built. We believe that Amazing Care starts from within, and our culture is reflective of this philosophy.

• A wide range of health insurance options including medical, dental and vision
• Strong bonus program
• A robust 401k and company match
• Truescripts is transitioning to an ESOP, a team member owned company! Each year team members are allocated shares of stock through our ESOP, a Qualified Retirement plan!
• A wellness program including financial incentives, chiropractic and massage services, and fitness stipends
• A cohesive, family-based culture
• Charitable contributions and volunteer time
• Lots of celebrations!

A future team members' values need to align with TrueScripts' core values of Integrity, Respect, Innovation, and Service. This match in value systems is critical for our team's chemistry and continued success. Our culture is positive, and our people possess a 'can do, proactive attitude. Honesty and transparency are the foundation that we build upon. What sets us apart from our competitors is the programs that we bring, the education that we provide, and the utmost respect for clients and their members to assist them when and where needed.

• Draft clinical criteria policies and question sets for medications requiring prior authorization, informed by current FDA labeling, clinical guidelines, and drug compendia.
• Perform initial quality checks on drafted content to ensure clinical accuracy and alignment with current guidelines before submission for pharmacist review.
• Use dashboards and reporting, with support from the Prior Authorization Coordinator Team, to proactively identify medications needing new or updated criteria.

• Submit draft criteria for formal review and approval, first by internal pharmacists, then by the policy committee.
• Prepare summary materials and supporting documentation for policy committee review and presentations.
• Maintain a master tracking log of all criteria in Confluence, with support from the Quality Committee Champion, including approval and effective dates, next scheduled review date, and version history, to ensure the annual (or sooner) review cadence is met.

• Build approved clinical criteria and question sets into the prior authorization platform.
• Develop and execute test cases to validate question logic, branching, and outcomes prior to production release.
• Migrate approved, tested policies to the production environment.
• Maintain version control across draft, approved, and production policies to avoid discrepancies.

• Build and maintain PA-related forms (e.g., prescriber fax forms, clinical information requests) and correspondence templates (approval letters, denial letters, appeal rights notices) within the prior authorization platform.
• As guided by Compliance, research and incorporate state-specific requirements — turnaround times, required notice language, appeal rights, step therapy override laws — into criteria, forms, and letters.
• As guided by Compliance,…