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.
Key Responsibilities
Professionals in this role may contribute to:
Pharmacy Prior Authorization Review
- 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
Specialty Medication Access & Payer Criteria Evaluation
- 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
Structured Feedback & Quality Control
- 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
Ideal Profile
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
Educational Background
- 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
Nice to Have
- 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
Why This Opportunity
- Apply pharmacy prior authorization and specialty medication access expertise to structured remote healthcare project work
- Contribute to high-quality AI-assisted pharmacy benefit and medication access evaluation
- Use payer criteria knowledge, documentation review skills, and specialty drug workflow experience in a focused review environment
- Work on flexible assignments aligned with pharmacy access, prior authorization, specialty medication, and payer workflow expertise
- Remote structure with competitive hourly compensation
Contract Details
- Independent contractor role
- Fully remote with flexible scheduling
- United States-based professionals are required for this opportunity
- Part-time project-based commitment depending on availability, onboarding status, and project needs
- Competitive rates of up to $55 per hour depending on pharmacy access experience, prior authorization expertise, specialty medication background, and project scope
- Weekly payments via Stripe or Wise
- Projects may be extended, shortened, or adjusted depending on scope and performance
- Work will not involve access to confidential or proprietary information from any employer, client, or institution
About the Platform
This opportunity is available through 24-MAG LLC. We connect experienced professionals with remote consulting opportunities across technical, evaluation, and project-based workstreams.
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