Clinical Authorization Specialist

Location: Brookline, Massachusetts, United States; remote work with occasional onsite attendance

Salary: $83,500–$95,400 per year

Company

hirify.global provides cancer research, education, and comprehensive patient care.

What you will do

• Manage clinically complex prior authorizations for on-label and off-label drugs, laboratory testing, molecular pathology, and other services.
• Discuss medical necessity cases with attending physicians and communicate clinical information to health plans.
• Conduct medical literature searches and coordinate provider-to-payer medical director discussions.
• Monitor authorization inquiries, triage requests, and resolve complex payer-related questions.
• Review denials, coordinate appeals, reprocess claims, and identify root causes of claim denials.
• Create drug cost estimates, waivers, and ABNs while guiding clinical teams on available assistance programs.

Requirements

• Bachelor’s degree required; BSN preferred.
• At least 1 year of clinical or related experience required.
• Ability to analyze medical information, solve problems, prioritize work, and meet deadlines in a high-volume environment.
• Ability to work with sensitive patient information and maintain confidentiality.
• Ability to collaborate effectively with medical staff and colleagues across the organization.
• Registered Nurse license in the Commonwealth of Massachusetts is preferred.

Nice to have

• Experience in case management, utilization review, or prior authorization.
• Knowledge of third-party payer rules and regulations.
• Experience mentoring and educating team members.

Culture & Benefits

• Fast-paced, high-volume, and dynamic work environment.
• Remote work arrangement with occasional onsite attendance.
• Work alongside clinicians, revenue integrity staff, billing compliance teams, and health plans.
• Inclusive and equitable environment focused on compassionate patient care.