Orange Tree System (OTS) is seeking a motivated Pharmacist for a Prior Authorization Specialist role (also known as Clinical Authorization Coordinator. This is a non-clinical healthcare role ideal for professionals who want to combine clinical knowledge, insurance workflows, and healthcare technology within a U.S.-style healthcare environment.

This role supports prior authorization, utilization management, medical necessity review, and payer compliance processes while leveraging AI-powered healthcare tools to improve efficiency and accuracy.

PharmD students and fresh graduates are encouraged to apply.

Key Responsibilities:

• Review and process prior authorization requests for medical services, procedures, and prescription medications
  
• Apply clinical judgment, evidence-based guidelines, and payer policies to determine medical necessity
  
• Ensure compliance with HIPAA, CMS, and payer-specific authorization standards
  
• Collaborate with physicians, pharmacists, nurses, and healthcare providers to obtain clinical documentation
  
• Maintain accurate case documentation within EHR / EMR systems
  
• Support authorization denials, reconsiderations, and appeals
  
• Utilize AI-driven tools to streamline workflows and improve decision-making efficiency

Required Qualifications:

• Strong knowledge of medical terminology.
  
• Prior experience in prior authorization, utilization management, clinical review, medical billing or medical insurance workflows (preferred)
  
• Excellent communication, analytical, and organizational skills
  
• High attention to detail and ability to manage multiple cases efficiently

Preferred Qualifications

• Bachelors degree in Pharmacy, Allied Health, or related healthcare discipline
  
• Preferred credentials: PharmD, MBBS, DPT
  
• Familiarity with EHR/EMR systems, health insurance portals, and U.S. healthcare workflows
  
• Ability to work independently in a fast-paced, technology-driven environment

Why Join Orange Tree System (OTS)?

• Access to cutting-edge AI healthcare tools for faster learning and productivity
• Improve medical communication and professional English, supporting international healthcare exams
• Gain exposure to U.S. healthcare operations, internships, and career pathways
• Innovation-driven culture that values creativity, ownership, and impact
• No-boss culture with a flat structure focused on mentorship and growth
• Work in a U.S.-style healthcare ecosystem blending operations, learning, and innovation