Prior Authorization Clinical Criteria – Policy Coordinator

TrueScripts Management Services

. Draft clinical criteria policies and question sets for medications requiring prior authorization using FDA labeling, clinical guidelines, and drug compendia .

Posted 10/2/2026full-timeRemote • Washington • United StatesMid-LevelSenior💰 $25 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in drafting clinical criteria policies and managing prior authorization processes, with strong research skills in FDA labeling and clinical guidelines. Proficient in utilizing Confluence and prior authorization platforms while ensuring compliance with regulatory standards.

Highest-signal resume keywords

Pharmacy Technician ExperiencePrior Authorization Platform ProficiencyClinical Criteria DraftingStrong Research SkillsExcellent Written Communication

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Criteria DraftingPrior Authorization ManagementResearch and Interpretation of FDA LabelingQuality Checks for Clinical AccuracyTest Case DevelopmentVersion ControlPolicy DocumentationData AnalysisProject ManagementCompliance Adherence

Soft Skills

Strong Organizational SkillsAttention to DetailProblem-Solving SkillsAnalytical ThinkingCollaboration

Tools & Technologies

ConfluenceMicrosoft Office 365Prior Authorization PlatformKnowledge Management ToolsWorkflow Software

Industry Keywords

Prior AuthorizationPharmacy Benefit Management (PBM)Clinical GuidelinesDrug CompendiaState-Specific RequirementsURAC/NCQA ComplianceConfidentiality GuidelinesPersonal Health Information (PHI)

About the role

Key responsibilities & impact

Draft clinical criteria policies and question sets for medications requiring prior authorization using FDA labeling, clinical guidelines, and drug compendia
Perform initial quality checks for clinical accuracy and guideline alignment
Identify medications needing new or updated criteria using dashboards and reporting
Submit criteria for pharmacist and policy committee review and approval
Prepare summary materials and supporting documentation for policy committee review
Maintain the master criteria tracking log in Confluence, including approvals, effective dates, review dates, and version history
Build approved criteria and question sets in the prior authorization platform
Develop and execute test cases for question logic, branching, and outcomes
Migrate approved and tested policies to production and maintain version control
Build and maintain prior authorization forms and correspondence templates
Research and incorporate state-specific prior authorization requirements under Compliance guidance
Maintain reference logs of state-specific requirements by state and client/plan
Implement compliant member notifications for approvals, denials, and appeal rights
Steward the Confluence criteria repository and archive retired or superseded criteria
Create and update job aids for the Prior Authorization Coordinator Team
Communicate criteria updates and workflow changes to internal teams and stakeholders
Serve as a subject matter resource on criteria application
Support client, URAC/NCQA, and state regulatory audits
Audit criteria effective dates and alignment with plan parameters
Assist with appeals or grievance reviews by providing criteria documentation and rationale
Manage expedited criteria development for urgent situations
Perform other duties as assigned

Requirements

What you’ll need

High school diploma required; two-year degree preferred
Pharmacy technician experience strongly preferred
Experience with pharmacy prior authorizations, PBM operations, or clinical criteria drafting strongly preferred
Strong research skills, including the ability to interpret FDA labeling, clinical guidelines, and drug literature
Excellent written communication skills for policy drafting, documentation, and cross-team communication
Experience with a prior authorization platform or similar processing/workflow software preferred
Familiarity with Confluence or similar knowledge management tools
Strong organizational skills and attention to detail; ability to manage multiple criteria projects simultaneously
Proficiency in Microsoft Office 365 (Word, Excel, Outlook, etc.)
Ability to work independently while collaborating closely with pharmacists, the policy committee, and the Prior Authorization Coordinator Team
Proactive, detail-oriented mindset with strong problem-solving and analytical thinking skills
Ability to sit, use hands and fingers, and type for up to eight hours in a workday
Must understand and adhere to Confidentiality and Personal Health Information (PHI) Guidelines as stated in the Employee Handbook

Benefits

Comp & perks

A wide range of health insurance options including medical, dental and vision
Strong bonus program
Robust 401k and company match
ESOP with annual stock allocations through a Qualified Retirement plan
Wellness program including financial incentives, chiropractic and massage services, and fitness stipends
Cohesive, family-based culture
Charitable contributions and volunteer time
Lots of celebrations!