Special Authorization Analyst II – Clinical Drug Services

🔥 0 minutes ago

🇨🇦 Canada – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 10%

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Alberta Blue Cross

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1940

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Alberta Blue Cross is a non-profit organization dedicated to providing comprehensive health benefits and wellness programs to the residents of Alberta. As a leader in preventative health care, Alberta Blue Cross serves over 1. 8 million people through group, government, and individual plans. The company is committed to promoting wellness, offering modern work environments, and supporting community health initiatives. It aims to empower Albertans to live healthy and fulfilling lives by addressing physical, mental, social, and financial well-being.

📋 Description

• Assess Special Authorization requests and determine eligibility for requested drug therapies • Apply evidence-based guidelines, clinical expertise, and clinical judgment to medication coverage decisions • Interpret clinical information, accepted medical conditions, and plan criteria • Record decision rationale and required information in Alberta Blue Cross computer systems to support claims adjudication and continuity of member access • Prepare clinically informed correspondence for prescribers and subscribers regarding Special Authorization decisions • Respond to electronic and telephone inquiries from internal and external customers • Explain decision outcomes, requirements, and next steps in a professional, member-focused manner

🎯 Requirements

• Preferred post-secondary education in Pharmacy, Pharmacology, Health Sciences, Nursing, or similar clinical disciplines; experienced Pharmacy Technicians and existing special authorization professionals may also be considered • Knowledge of pharmacotherapy, disease states, treatment guidelines, drug reimbursement principles, and clinical decision-making • Preferred experience in Special Authorization, drug benefits administration, pharmacy practice, formulary management, drug utilization review, or health insurance adjudication • Strong analytical, problem-solving, and decision-making skills • Ability to manage time effectively, work independently, and contribute to a collaborative team environment • High degree of accuracy, attention to detail, and commitment to quality work • Proficiency with Microsoft Office, including Word and Excel; Access experience is considered an asset • Excellent written and verbal communication skills, supported by strong organizational abilities • Ability to adapt to changing priorities and manage competing demands in a fast-paced environment • Collaborative team player with a positive and flexible approach • Service-oriented and responsive, with the ability to build and maintain effective relationships with internal and external customers • Ability to work occasional weekdays until 5:00 pm, weekends, and statutory holidays on a rotation basis • Satisfactory criminal record check required as a condition of employment following a conditional offer

🏖️ Benefits

• Healthy work-life balance • Opportunities for career growth • Innovative, high-energy, team-focused work environment • Inclusive workplace that welcomes, respects, and values diverse perspectives, backgrounds, and experiences

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