NAM Info Inc
Life Sciences Business Architect-Pre-Authorization experience on the provider si
NAM Info Inc, Los Angeles, California, United States, 90079
Note:
Send resumes to
Venki@nam-it.com
for quick submittals.
Position: Life Sciences Business Architect-Pre-Authorization experience on the provider side. Location: Valencia, CA-local candidates Duration: 12+ Months Project
we are specifically looking for a Life Sciences Business Architect with a strong Life Sciences background and Pre-Authorization experience on the provider side.
Domain Consultant – Pre-Authorization (Life Sciences)
Role Overview - Valencia, CA We are seeking an experienced
Domain Consultant
with deep expertise in the
Pre-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 a
subject matter expert (SME)
in pre-authorization workflows, covering medical necessity, clinical documentation, prior authorization rules, and payer–provider interactions. Support clients in
transforming pre-auth processes
to improve speed, compliance, and patient experience. Analyze existing business processes, identify gaps, and design
target operating models
for pre-auth. Partner with technology teams to shape
digital and GenAI solutions
(e.g., automated prior authorization, real-time benefit checks, interoperability with EMR/EHR). Advise on
compliance with CMS, FDA, and global regulations
around pre-authorization, patient safety, and access. Collaborate with product managers, architects, and delivery teams to ensure
business requirements are translated into solution designs . Conduct
workshops with client stakeholders
to gather business requirements, define KPIs, and build consensus. Contribute to
thought leadership
(white papers, PoVs, webinars) on pre-auth trends and innovation in life sciences.
Required Skills & Experience 7–12 years of domain experience
in Life Sciences, Healthcare, or Payer/Provider organizations, with at least
3–5 years focused on pre-authorization or utilization management . Strong knowledge of: Prior authorization workflows (medical and pharmacy benefits) Interoperability standards (HL7 FHIR, X12, NCPDP) Clinical guidelines and evidence-based medical policy Patient access and affordability challenges Exposure to
payer and provider systems
(EHR, claim processing, benefit management). Experience in
consulting or business analysis
roles, preferably with global clients. Proven ability to
liaise between business and technology teams . Excellent communication, presentation, and stakeholder management skills.
Preferred Qualifications Experience with
CMS interoperability mandates
(e.g., CMS-0057-F, PA APIs). Knowledge of
life sciences value chain
(pharma/biotech market access, hub services, patient support programs). Familiarity with
AI/ML and automation use cases
in pre-auth and utilization management. Prior experience in a
consulting firm or digital transformation environment . Bachelor’s or Master’s degree in
Life Sciences, Healthcare Management, Pharmacy, or related field ; MBA preferred.
Send resumes to
Venki@nam-it.com
for quick submittals.
Position: Life Sciences Business Architect-Pre-Authorization experience on the provider side. Location: Valencia, CA-local candidates Duration: 12+ Months Project
we are specifically looking for a Life Sciences Business Architect with a strong Life Sciences background and Pre-Authorization experience on the provider side.
Domain Consultant – Pre-Authorization (Life Sciences)
Role Overview - Valencia, CA We are seeking an experienced
Domain Consultant
with deep expertise in the
Pre-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 a
subject matter expert (SME)
in pre-authorization workflows, covering medical necessity, clinical documentation, prior authorization rules, and payer–provider interactions. Support clients in
transforming pre-auth processes
to improve speed, compliance, and patient experience. Analyze existing business processes, identify gaps, and design
target operating models
for pre-auth. Partner with technology teams to shape
digital and GenAI solutions
(e.g., automated prior authorization, real-time benefit checks, interoperability with EMR/EHR). Advise on
compliance with CMS, FDA, and global regulations
around pre-authorization, patient safety, and access. Collaborate with product managers, architects, and delivery teams to ensure
business requirements are translated into solution designs . Conduct
workshops with client stakeholders
to gather business requirements, define KPIs, and build consensus. Contribute to
thought leadership
(white papers, PoVs, webinars) on pre-auth trends and innovation in life sciences.
Required Skills & Experience 7–12 years of domain experience
in Life Sciences, Healthcare, or Payer/Provider organizations, with at least
3–5 years focused on pre-authorization or utilization management . Strong knowledge of: Prior authorization workflows (medical and pharmacy benefits) Interoperability standards (HL7 FHIR, X12, NCPDP) Clinical guidelines and evidence-based medical policy Patient access and affordability challenges Exposure to
payer and provider systems
(EHR, claim processing, benefit management). Experience in
consulting or business analysis
roles, preferably with global clients. Proven ability to
liaise between business and technology teams . Excellent communication, presentation, and stakeholder management skills.
Preferred Qualifications Experience with
CMS interoperability mandates
(e.g., CMS-0057-F, PA APIs). Knowledge of
life sciences value chain
(pharma/biotech market access, hub services, patient support programs). Familiarity with
AI/ML and automation use cases
in pre-auth and utilization management. Prior experience in a
consulting firm or digital transformation environment . Bachelor’s or Master’s degree in
Life Sciences, Healthcare Management, Pharmacy, or related field ; MBA preferred.