Prior Authorization Clinical Pharmacist

This is a fully remote position, open to applicants in North Carolina, +1 more state.

📋 Description

• Assess and oversee the selection and use of pharmaceuticals to ensure safe, effective, and cost-efficient medication practices.

• Assist with Drug Utilization Review, Drug Information Services, and formulary management initiatives.

• Conduct research and compile comprehensive clinical pharmaceutical data.

• Create and deliver therapeutic class reviews and drug monographs to the Pharmacy and Therapeutics Committee.

• Evaluate and authorize or reject pharmaceutical coverage based on established medical necessity criteria, where applicable.

• Collaborate with internal stakeholders and health plan medical directors.

• Act as a clinical resource for pharmacists regarding prospective, inpatient, and retrospective DURs.

• Offer dosage conversion and clinical support for therapeutic interventions.

• Prepare relevant information for network physicians.

• Provide clinical advice on therapeutic interventions, dosage conversions, and evidence-based medication applications.

• Develop and relay drug information and recommendations to network physicians and clinical teams.

⛳️ Requirements

• BA/BS in Pharmacy.

• At least 2 years of managed care pharmacy (PBM) experience or completion of a residency in place of work experience.

• Registered pharmacist.

• Current unrestricted Pharmacist license in applicable state(s).

• For associates working in Puerto Rico who are member or patient-facing in a clinical setting or Best Transportation unit: current PR health certificate and current PR Law 300 certificate.

• Active, unrestricted RPh license in North Carolina and/or Washington is highly preferred.

• PharmD is preferred.

• PBM experience is preferred.

• Prior Authorization experience is preferred.

• Specialty Medication experience is preferred.

• Must reside in a state or territory of the United States when conducting utilization review or appeals consideration, unless permitted by law or regulation.

• Cannot be based on a US military base, vessel, or embassy unless performing command-sanctioned activities.

• Excellent oral, written, and interpersonal communication skills.

• Strong problem-solving abilities.

• Effective facilitation skills.

• Proficient analytical skills.

🏝️ Benefits

• Associate Referral Bonus: $250.

• Comprehensive benefits package.

• Merit increases.

• Paid holidays.

• Paid Time Off.

• Incentive bonus programs.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• Short- and long-term disability benefits.

• 401(k) + match.

• Stock purchase plan.

• Life insurance.

• Wellness programs.

• Financial education resources.

• Virtual full-time work arrangement, except for required in-person training sessions.

• Equity.