Drug Prior Authorization Case Manager
Manulife — 5 Locations
Posted 2026-10-02
The Drug Prior Authorization Case Manager is accountable for the full service, end to end management of our most complex Prior Authorization claims including directly communicating with members and providers. The Case Manager must possess the knowledge and expertise required to manage cases with total autonomy, while meeting service expectations to ensure excellent customer experience. This role is responsible for managing all claims situations that have unique handling requirements including those that fall outside the scope of system automation and global resourcing. Also includes the undertaking of challenging scenarios involving extensive research, sensitive/escalated issues and high dollar value claims. The Case Manager provides direct support to a variety of stakeholders in the organization and is considered a subject matter expert who handles inquiries from various internal and external sources as well as providing peer training. Position Responsibilities: Claims Adjudication & Prior Authorization Management (60%) Manage the intake, review, and adjudication of Prior Authorization drug requests, assessing submissions against clinical guidelines, plan provisions, and documente