Pharmacist / Prior Authorization Specialist
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Job Description
Orange Tree Systems (OTS) is hiring Pharmacists for the Prior Authorization Specialist role to support U.S. healthcare prior authorization and utilization management processes. This is a non-clinical, operations-focused role ideal for healthcare professionals who want to apply their clinical knowledge in a technology-driven, U.S.-style healthcare environment.
This position is well-suited for licensed pharmacists, PharmD graduates, and PharmD students who are eager to gain exposure to insurance workflows and AI-enabled healthcare operations. PharmD students are encouraged to apply.
Key Responsibilities
- Review and process prior authorization requests for medical services, procedures, and prescription medications
- Apply clinical judgment and evidence-based criteria to determine medical necessity
- Ensure compliance with HIPAA
- Collaborate with physicians, pharmacists, nurses, and healthcare providers to obtain supporting clin...