Drug Prior Authorization Case Manager

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

• This role is responsible for the end-to-end management of complex drug prior authorization and claims cases.
• You will independently assess requests against clinical guidelines, plan provisions, and approval criteria while ensuring accurate and timely decisions.
• The position involves direct communication with members, providers, pharmacies, and internal stakeholders.
• You will handle sensitive, escalated, high-value, and non-standard cases that require research, sound judgment, and detailed analysis.
• As a subject matter expert, you will also support internal teams, outsource partners, training, and knowledge-sharing initiatives.
• The role combines customer service, claims expertise, risk management, and continuous improvement within a collaborative and evolving environment.