Prior Authorization Guideline Specialist

Full-time Business Operations Specialists

Job description:

Locations: Cebu / Makati, Philippines (2 Openings – 1 per site)
Employment Type: Full-time
Start Date: Can start ASAP

Job Overview

We are seeking a detail-oriented Prior Authorization Guidelines Specialist to provide technical and administrative support to the Fee-For-Service (FFS) Medicaid pharmacy operations team. This role works closely with Clinical Account Executives, Clinical Specialists, and Pharmacy Prior Authorization (PA) and Drug Information teams to ensure accurate development, maintenance, and implementation of Medication Request Guidelines and related clinical documentation.

The role plays a key part in supporting Prior Authorization (PA) processes, guideline management, and electronic rule implementation used in pharmacy benefit operations.

Key Responsibilities

Develop, update, and maintain Prior Authorization (PA) Guideline documents, including content management, v...