Prior Authorization Guidelines Specialist I (CPhT)

Location: On-site at the San Diego Headquarters or another company location; remote work requires management approval based on business requirements. Typical hours are Monday through Friday, 8:00 a.m. to 5:00 p.m., with occasional nights, weekends, holidays, and overtime as required.

Salary: $22.99–$30.35–$37.71 per hour.

Company

hirify.global provides pharmacy benefit management, healthcare, pharmaceutical, and technology solutions for payers, providers, and consumers.

What you will do

• Create, maintain, archive, code, and link prior authorization guideline documents in electronic systems.
• Format, verify, test, and develop Medication Request Guidelines, Medication Request Forms, and electronic rules.
• Coordinate with client teams, Clinical Program Managers, Clinical Specialists, Drug Information staff, and prior authorization teams.
• Obtain client approval for final documents and distribute information to the appropriate departments.
• Manage quality assurance reviews before medical exception and prior authorization guidelines are implemented.
• Support prior authorization research, implementation, processing, and related internal and external client inquiries.

Requirements

• Associate degree and at least 2 years of experience, or an equivalent combination of education and experience.
• Current unrestricted pharmacy license and/or CPhT certification; must successfully complete a national certification exam or obtain state licensure in a U.S. state or territory.
• Intermediate knowledge of Microsoft Word, Excel, Outlook, Windows-based database programs, and the ability to learn new applications.
• Understanding of managed pharmacy benefit concepts, including formularies, prior authorizations, edits, and claims adjudication.
• Strong written, verbal, listening, customer service, organizational, and problem-solving skills.
• Must be eligible to work in the United States; this position is not eligible for sponsorship.

Culture & Benefits

• Full-time, non-exempt employment with medical, dental, vision, and wellness programs.
• Paid time off and company-paid holidays.
• 401(k) plan with company match, life and disability insurance, and incentive compensation.
• Tuition reimbursement and employee referral bonus.
• No regular travel; occasional attendance may be required at local conferences and meetings.