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.