Opportunity Description
Orange Tree Systems (OTS) is hiring experienced pharmacists for the Prior Authorization Specialist role. The focus is on applying clinical knowledge to U.S. healthcare operations, not dispensing medications or counting tablets.
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.
- Maintain compliance with HIPAA.
- Collaborate with physicians, pharmacists, nurses and other healthcare providers to obtain supporting clinical documentation.
- Maintain accurate and detailed case records within EHR/EMR systems.
- Assist with authorization denial appeals as required.
- Utilize AI‑powered tools to streamline workflows and improve efficiency and decision‑making.
Requirements
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