Pharmacist
3 days ago
Blue Health
is seeking a motivated
Prior Authorization Specialist
(also known as
Clinical Authorization Coordinator
) with a
medical or allied health science background
to support our prior authorization process. This is a
non-clinical role
designed for healthcare professionals eager to combine medical expertise with cutting-edge technology in a modern, innovation-driven environment modeled on
U.S. healthcare standards
.
(Medical students are encouraged to apply)
Key Responsibilities:
- Review and process prior authorization requests for medical services, procedures, and prescriptions.
- Apply clinical judgment and payer guidelines to assess medical necessity.
- Ensure compliance with
HIPAA
and payer-specific standards. - Collaborate with physicians, pharmacists, and healthcare providers to obtain supporting documentation.
- Maintain detailed and accurate case records in
EHR/EMR systems
. - Assist in managing denials and appeals when required.
- Use
AI-powered tools
to streamline workflows and enhance decision-making efficiency.
Requirements:
- Educational background in
Nursing, Pharmacy, or Allied Health Sciences
(RN, LPN, BSN, PharmD, CPhT, or equivalent). - Strong knowledge of medical terminology and insurance payer guidelines.
- Prior experience in
utilization management
,
authorization
, or
clinical review
is highly preferred. - Excellent communication, organization, and analytical skills with great attention to detail.
Preferred Qualifications:
- Bachelor's degree in
Nursing, Pharmacy, Allied Health
, or an equivalent clinical discipline. - Preferred:
MBBS, DPT, or PharmD. - Ability to work independently in a
fast-paced, tech-enabled
environment. - Familiarity with
EHR/EMR systems
and healthcare insurance workflows.
Why Join Blue Health?
- Access to cutting-edge AI tools
that boost learning, efficiency, and communication. - Working here naturally improves your
accent and communication skills
, helping you excel in international healthcare language exams. - Professional connections & internship opportunities
within the U.S. healthcare system. - A culture that
rewards innovation, encourages creativity
, and recognizes individual contributions. - No-boss culture:
flat, collaborative structure focused on mentorship and personal growth. - Experience a
U.S.-style healthcare work environment
blending operations, learning, and innovation.
Apply now
to join a team shaping the future of healthcare operations through innovation, collaboration, and global exposure.
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