Outpatient Medical Approvals Physician/Pharmacist

About the role

The Outpatient Medical Approvals Physician/Pharmacist is responsible for reviewing outpatient medical requests to ensure they align with established clinical guidelines and reference policies. This role supports timely, evidence‑based coverage and authorization decisions while maintaining high standards of patient care and regulatory compliance.

Key responsibilities

• Review outpatient medical requests against clinical guidelines and reference policies.
• Make accurate, evidence‑based decisions on coverage and authorization within defined turnaround times.
• Collaborate with healthcare providers to clarify clinical information when needed.
• Document decisions and maintain compliance with regulatory and organizational standards.
• Support optimal patient outcomes by ensuring appropriate medical services are approved.

Required profile

• Qualified physician or pharmacist with experience in outpatient care.
• Strong knowledge of clinical guidelines, reference policies, and regulatory requirements.
• Excellent analytical and decision‑making abilities.
• Effective communication skills for interaction with healthcare providers.

Required skills