We are seeking an experiencedDomain Consultantwith deep expertise in thePre-Authorization (Pre-Auth) space within Life Sciences and Healthcare. The ideal candidate will bring a strong understanding of payer, provider, and life sciences ecosystems, including regulatory frameworks, utilization management, patient access, and digital transformation trends. This role will combine domain knowledge, client advisory, and solution design to drive strategic engagements for pharmaceutical, biotech, and med-tech clients.
Key Responsibilities
* Act as asubject matter expert (SME)in pre-authorization workflows, covering medical necessity, clinical documentation, prior authorization rules, and payer–provider interactions.
* Support clients intransforming pre-auth processesto improve speed, compliance, and patient experience.
* Analyze existing business processes, identify gaps, and designtarget operating modelsfor pre-auth.
* Partner with technology teams to shapedigital and GenAI solutions(e.g., automated prior authorization, real-time benefit checks, interoperability with EMR/EHR).
* Advise oncompliance with CMS, FDA, and global regulationsaround pre-authorization, patient safety, and access.
* Collaborate with product managers, architects, and delivery teams to ensurebusiness requirements are translated into solution designs.
* Conductworkshops with client stakeholdersto gather business requirements, define KPIs, and build consensus.
* Contribute tothought leadership(white papers, PoVs, webinars) on pre-auth trends and innovation in life sciences.
Required Skills & Experience
* 7–12 years of domain experiencein Life Sciences, Healthcare, or Payer/Provider organizations, with at least3–5 years focused on pre-authorization or utilization management.
* Strong knowledge of:
o Prior authorization workflows (medical and pharmacy benefits)
o Interoperability standards (HL7 FHIR, X12, NCPDP)
o Clinical guidelines and evidence-based medical policy
o Patient access and affordability challenges
* Exposure topayer and provider systems (EHR, claim processing, benefit management).
* Experience inconsulting or business analysisroles, preferably with global clients.
* Proven ability toliaise between business and technology teams.
* Excellent communication, presentation, and stakeholder management skills.
Preferred Qualifications
* Experience withCMS interoperability mandates(e.g., CMS-0057-F, PA APIs).
* Knowledge oflife sciences value chain(pharma/biotech market access, hub services, patient support programs).
* Familiarity withAI/ML and automation use casesin pre-auth and utilization management.
* Prior experience in aconsulting firm or digital transformation environment.
* Bachelor’s or Master’s degree inLife Sciences, Healthcare Management, Pharmacy, or related field; MBA preferred.
Cloud Hybrid is an equal opportunity employer inclusive of female, minority, disability and veterans, (M/F/D/V). Hiring, promotion, transfer, compensation, benefits, discipline, termination and all other employment decisions are made without regard to race, color, religion, sex, sexual orientation, gender identity, age, disability, national origin, citizenship/immigration status, veteran status or any other protected status. Cloud Hybrid will not make any posting or employment decision that does not comply with applicable laws relating to labor and employment, equal opportunity, employment eligibility requirements or related matters. Nor will Cloud Hybrid require in a posting or otherwise U.S. citizenship or lawful permanent residency in the U.S. as a condition of employment except as necessary to comply with law, regulation, executive order, or federal, state, or local government contract.
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