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AI Summary
About mpathic.ai
mpathic is keeping humans safe in the AI era through automated tools and expert datasets that are rooted in psychology and powered by clinicians.
We are a series A start-up backed by Tier 1 investors including Foundry.vc and Next Frontier Capital.
If you have applied for an expert role within the past 12 months, you do not need to reapply.
About the role
Your expertise in specialty medication access, pharmacy benefits, payer policies, and prior authorization will help ensure AI systems produce accurate, clinically sound, and policy-compliant recommendations. You'll review real-world scenarios, evaluate AI-generated outputs, and provide the feedback that helps make these systems more reliable for patients, providers, and care teams.
What You'll Do
- Evaluate AI-generated prior authorization recommendations for accuracy, completeness, and alignment with payer requirements.
- Review specialty medication requests using your expertise in formularies, step therapy protocols, and pharmacy benefit policies.
- Assess supporting clinical documentation and determine whether AI outputs reflect appropriate medical necessity criteria.
- Apply structured evaluation guidelines to annotate model responses and identify errors, gaps, and opportunities for improvement.
- Provide clear, actionable feedback that helps improve AI performance on complex pharmacy authorization workflows.
- Assess AI outputs involving coordination with prescribers, specialty pharmacies, and payers throughout the authorization process.
- Bring real-world knowledge of specialty medication access to help shape safer, more trustworthy healthcare AI.
Qualifications
- 5+ years of experience in pharmacy prior authorization, specialty medication access, pharmacy benefit management, or a closely related field.
- Deep understanding of specialty drug formularies, step therapy requirements, and payer authorization criteria across commercial and government health plans.
- Experience working with specialty pharmacy platforms, pharmacy benefit management (PBM) systems, or medication access programs.
- Strong written English and the ability to communicate complex clinical and policy concepts clearly.
- Exceptional attention to detail and strong judgment when reviewing clinical documentation and AI-generated outputs.
Nice to Have
- Certified Pharmacy Technician (CPhT), Certified Prior Authorization Professional (CPAP), or similar credential.
- Experience supporting specialty pharmacy, infusion services, oncology, rheumatology, or other high-cost therapeutic areas.
- Experience evaluating clinical documentation for payer compliance and medication access decisions.
- Interest in AI and emerging healthcare technologies, including experience reviewing or evaluating AI-generated content.
Compensation
This is a contract, project-based position. The hourly rate will depend on experience and project parameters. The rate will be disclosed prior to starting the project.
IMPORTANT - How to Apply
We can only accept and review and applications via our direct official recruiting portal: https://mpathic2.bamboohr.com/careers, due to the abundance of 3rd party apps and automated agents. Only applications submitted directly by the applicant through our portal will be considered.
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