Special Authorization Analyst II – Clinical Drug Services

Job summary

Assess Special Authorization requests by applying clinical expertise and evidence-based guidelines to determine medication coverage eligibility. Document decision rationales in company systems and provide professional correspondence to prescribers and subscribers regarding coverage outcomes.

Job details

Alberta Blue Cross® is an Alberta based organization dedicated to delivering exceptional customer experience and community leadership. We’re committed to providing the best health coverage to over 1.8 million members and take an active role in promoting wellness. We believe in what we do—and place trust in our employees to deliver our vision. Working at Alberta Blue Cross® means having a career where you’ll be recognized for your contributions. We value diversity, encourage our team members to maintain a healthy work-life balance and provide opportunities for career growth. OVERVIEW: Our Special Authorization Analyst II team is growing. This position plays a critical clinical decision-making role in assessing Special Authorization requests and determining appropriate medication coverage within established standards. Special Authorization is a process where prescribers can request coverage for specific drugs for their patients, and this role requires clinicians to apply evidence-based guidelines, clinical judgment, and a strong understanding of member needs to support timely access to medications. WHAT YOU WILL DO: Apply clinical expertise to assess Special Authorization requests, determine eligibility for requested drug therapies, and make decisions that directly impact member access to medications. Interpret clinical information, accepted medical conditions, and plan criteria to ensure decisions are accurate, consistent, and clearly documented. Record decision rationale and required information in Alberta Blue Cross® computer systems to support appropriate claims adjudication and continuity of member access. Prepare clear, clinically informed correspondence for prescribers and subscribers regarding Special Authorization decisions. Respond to electronic and telephone inquiries from internal and external customers by explaining decision outcomes, requirements, and next steps in a professional and member-focused manner. The ability to work occasional weekdays until 5:00 pm, weekends, and statutory holidays on a rotation basis is required. WHAT YOU WILL HAVE: Preferred post-secondary education in Pharmacy, Pharmacology, Health Sciences, Nursing, or similar clinical disciplines. Or, experienced Pharmacy Technicians and existing special authorization professionals. Knowledge of pharmacotherapy, disease states, treatment guidelines, drug reimbursement principles, and clinical decision-making. Preferred experience in Special Authorization, drug benefits administration, pharmacy practice, formulary management, drug utilization review, or health insurance adjudication. Strong analytical, problem-solving, and decision-making skills. Ability to manage time effectively, work independently, and contribute to a collaborative team environment. High degree of accuracy, attention to detail, and commitment to quality work. Proficiency with Microsoft Office, including Word and Excel; Access experience is considered an asset. Excellent written and verbal communication skills, supported by strong organizational abilities. Ability to adapt to changing priorities and manage competing demands in a fast-paced environment. Collaborative team player with a positive and flexible approach. Service-oriented and responsive, with the ability to build and maintain effective relationships with internal and external customers. IDEAL CANDIDATE PROFILE: This role is well suited to pharmacology graduates, experienced pharmacy technicians, and drug benefits professionals who are looking to apply their medication knowledge in a meaningful alternative career path outside of traditional dispensing or frontline pharmacy practice. The ideal candidate is someone who enjoys analyzing clinical information, applying drug coverage criteria, and making thoughtful, evidence-informed decisions that influence whether members can access the medications they need. This opportunity may be especially attractive to experienced clinicians and pharmacy professionals seeking a role that offers clinical complexity, meaningful member impact, and the ability to contribute to medication access without the demands of a retail, hospital, or direct patient-care environment. This position will remain open until a suitable candidate is selected. Alberta Blue Cross® is an inclusive employer committed to a workplace that reflects the diversity of the communities we serve. We empower and are advocates for our team members by welcoming, respecting and valuing their unique perspectives, backgrounds, and experiences. We offer the opportunity to work in an innovative, high-energy team-focused environment. If you have the qualifications we are looking for, apply online at careers.ab.bluecross.ca A criminal record check satisfactory to Alberta Blue Cross will be required as a condition of employment, following a conditional offer.

What you’ll do

Assess Special Authorization requests by applying clinical expertise and evidence-based guidelines to determine medication coverage eligibility. Document decision rationales in company systems and provide professional correspondence to prescribers and subscribers regarding coverage outcomes.

Requirements

Requires post-secondary education in Pharmacy, Pharmacology, Health Sciences, Nursing, or equivalent clinical experience. Candidates must possess strong analytical skills and a solid understanding of pharmacotherapy and drug reimbursement principles.

Benefits

• Work-life balance • Career growth opportunities • Inclusive workplace

Listed skills

• Time management · Preferred
• Customer service · Preferred
• written communication · Preferred
• Problem solving · Preferred
• Collaboration · Preferred
• Attention to detail · Preferred
• Microsoft Office · Preferred

Other relevant skills

Identified from the job description. Confirm important requirements above.

• Clinical decision-making
• Pharmacotherapy
• Drug reimbursement principles
• Analytical skills
• Problem-solving
• Attention to detail
• Microsoft Office
• Written communication
• Verbal communication
• Time management
• Collaboration
• Customer service
• Data interpretation
• Formulary management
• Drug utilization review
• Influencing Skills
• Community Leadership
• Pharmacy Operations
• Energetic
• Direct Patient Care
• Influencing Without Authority
• Organizational Skills
• Drug Utilization Review
• Advocacy
• Microsoft Access
• Microsoft Excel
• Adjudication
• Benefits Administration
• Management
• Decision Making
• Customer Service
• Hospital Information Systems
• Health Sciences
• Innovation
• Problem Solving
• Nursing
• Pharmacology
• Time Management
• Verbal Communication Skills
• Detail Oriented

Job areas

• Healthcare
• Customer Service & Support
• Science & Research
• Administrative
• Pre-Authorization Specialist
• Drug Safety Specialist
• Environmental and Occupational Health and Hygiene Professionals
• Occupational Health and Safety Technicians