Clinical Prior Authorization Technician (Temp to Hire)

📋 Description

• • The Clinical Prior Authorization Technician (Temp to Hire) role at Capital Rx, Inc. is a remote position focused on preparing complex prior authorization requests by identifying clinical guidelines and ensuring sufficient clinical information exists for pharmacist review. This role is critical to ensuring timely and accurate medication access for patients while supporting the company’s mission to rebuild trust in healthcare through innovative health technology solutions.
• • Day-to-day responsibilities include proactively obtaining clinical information from prescribers and referral coordinators, triaging internal phone calls from members and providers to resolve concerns, reviewing and analyzing pharmacy claims data for proactive outreach, creating decision trees from clinical guidelines, communicating issues and resolutions to internal and external stakeholders, training call center technicians on prior authorization protocols, assisting with departmental projects, following Standard Operating Procedures, and supporting the Fraud, Waste, and Abuse program by reviewing claims and communicating findings.
• • The role operates within Judi Health, an enterprise health technology company that includes Capital Rx (a public benefit corporation PBM), Judi Health™ (health benefit management solutions), and Judi® (the Enterprise Health Platform). Together, these entities consolidate claim administration workflows into a scalable, secure platform to improve healthcare infrastructure and patient outcomes in the U.S.
• • In this role, the individual can develop expertise in prior authorization processes, clinical guideline interpretation, healthcare compliance, and cross-functional collaboration. They will gain hands-on experience with pharmacy benefit management systems, enhance problem-solving and communication skills, and contribute to meaningful healthcare operations—potentially leading to career advancement within a mission-driven organization focused on equitable, transparent healthcare access.