Location
Morris Plains, New Jersey
Job Type
Full-time
Posted
May 16, 2026
Job Description
No direct patientcare. This is a virtual position.
Responsible for clinical criteria prior authorization setup, which takes client clinical policy requirements and creates the prior authorization request sent to prescribers. This could include questions such as (but not limited to) is the patient 18, does this patient have , has the patient tried and failed these alternative medications etc. The creation of questions and answers along with other additional configuration will allow prescribers to answer questions leading to either an approval or denial. Clinicians are also responsible for creating and coding denial rationales sent to prescribers and patients. The system leveraged for this coding is a web-based platform proprietary to Client, and selected contractor will be trained on how to leverage this platform. Additionally, the individuals should have strong skills with Microsoft office, particularly Excel.
Configuration support will be for both pharmacy and medica...
Responsible for clinical criteria prior authorization setup, which takes client clinical policy requirements and creates the prior authorization request sent to prescribers. This could include questions such as (but not limited to) is the patient 18, does this patient have , has the patient tried and failed these alternative medications etc. The creation of questions and answers along with other additional configuration will allow prescribers to answer questions leading to either an approval or denial. Clinicians are also responsible for creating and coding denial rationales sent to prescribers and patients. The system leveraged for this coding is a web-based platform proprietary to Client, and selected contractor will be trained on how to leverage this platform. Additionally, the individuals should have strong skills with Microsoft office, particularly Excel.
Configuration support will be for both pharmacy and medica...