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 judgment, and member needs 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 • Support appropriate claims adjudication and continuity of member access • Prepare clinically informed correspondence for prescribers and subscribers • Respond to electronic and telephone inquiries from internal and external customers • Explain decision outcomes, requirements, and next steps professionally and in a 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 qualify • 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 and work independently and collaboratively • High degree of accuracy and attention to detail • Proficiency with Microsoft Office, including Word and Excel • Access experience considered an asset • Excellent written and verbal communication skills • Strong organizational abilities • Ability to adapt to changing priorities and manage competing demands • Service-oriented and responsive, with ability to build and maintain effective customer relationships • 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 values diversity and unique perspectives