Clinical Documentation Specialist / Prior Authorization Specialist (Medical / Allied Health Background)

Blue Health is seeking a motivated Prior Authorization Specialist (also known as Clinical Authorization Coordinator) with a medical or allied health science background to support our prior authorization process. This is a non-clinical role designed for healthcare professionals eager to combine medical expertise with cutting-edge technology in a modern, innovation-driven environment modeled on U.S. healthcare standards.(Medical students are encouraged to apply)Key Responsibilities:Review and process prior authorization requests for medical services, procedures, and prescriptions.Apply clinical judgment and payer guidelines to assess medical necessity.Ensure compliance with HIPAA and payer-specific standards.Collaborate with physicians, pharmacists, and healthcare providers to obtain supporting documentation.Maintain detailed and accurate case records in EHR/EMR systems.Assist in managing denials and appeals when required.Use AI-powered tools to streamline workflows and enhance decision-making efficiency.Requirements:Educational background in Nursing, Pharmacy, or Allied Health Sciences (RN, LPN, BSN, PharmD, CPhT, or equivalent).Strong knowledge of medical terminology and insurance payer guidelines.Prior experience in utilization management, authorization, or clinical review is highly preferred.Excellent communication, organization, and analytical skills with great attention to detail.Preferred Qualifications:Bachelor’s degree in Nursing, Pharmacy, Allied Health, or an equivalent clinical discipline.Preferred: MBBS, DPT, or PharmD.Ability to work independently in a fast-paced, tech-enabled environment.Familiarity with EHR/EMR systems and healthcare insurance workflows.Why Join Blue Health?🧠 Access to cutting-edge AI tools that boost learning, efficiency, and communication.🗣️ Working here naturally improves your accent and communication skills, helping you excel in international healthcare language exams.🤝 Professional connections & internship opportunities within the U.S. healthcare system.💡 A culture that rewards innovation, encourages creativity, and recognizes individual contributions.👥 No-boss culture: flat, collaborative structure focused on mentorship and personal growth.🇺🇸 Experience a U.S.-style healthcare work environment blending operations, learning, and innovation.Apply now to join a team shaping the future of healthcare operations through innovation, collaboration, and global exposure.