Prior Authorization Specialist

This job is with Blue Health Informatics. Blue Health builds healthcare technology and select complementary products that make a real difference. We move fast, learn continuously, and care deeply about the people who use our products and the teammates who build them.

Role Overview 

Blue Health is seeking a motivated Pharmacist for Prior Authorization Specialist job role (also known as Clinical Authorization Coordinator) 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.

(PharmD 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:

• 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:

• Bachelors 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.