Case Manager – Drug Prior Authorization

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Case Manager – Drug Prior Authorization based in Canada.

• This role plays a key part in managing complex drug prior authorization requests and claims requiring specialized handling.
• You will own cases end to end, assessing submissions against clinical guidelines, plan provisions, and established approval criteria.
• You will also manage sensitive, escalated, non-standard, and high-value cases that require sound judgment and in-depth analysis.
• The role involves regular communication with plan participants, healthcare providers, pharmacies, and internal stakeholders.
• You will serve as a subject matter expert on prior authorization and claims adjudication, while supporting knowledge sharing and colleague training.
• Your expertise will directly contribute to service quality, customer satisfaction, operational efficiency, and continuous improvement.
• You will work in a dynamic, flexible, and collaborative environment that values professional development, sound decision-making, and operational excellence.