Prior Authorization Pharmacist

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Oversee the evaluation of clinical documentation and the Preferred Drug List to establish appropriate medication therapy.

• Assess Prior Authorization requests from healthcare professionals utilizing the criteria set by the Preferred Drug List.

• Engage in peer-to-peer conversations with healthcare providers concerning Prior Authorization evaluations.

• Reach out to prescribers for consultations and deliver clinical insights on prescribing patterns identified as deviations.

• Analyze Prior Authorization data to identify potential opportunities for interventions.

• Collaborate in the enhancement of consultation scripts and utilize feedback to refine these scripts.

• Aid in the development and management of both written and verbal communications directed at members and physicians.

• Offer guidance on pharmacy-related queries and issues within the organization.

• Play a role in ongoing quality improvement and pinpoint potential areas for enhancement.

• Work together with product leaders, Medical Directors, Clinical Pharmacists, and Clinical Specialty Pharmacists.

• Maintain up-to-date knowledge on medication information and contribute to the best practices of pharmacy programs.

• Propose innovative solutions to enhance the operational efficiency and effectiveness of the pharmacy team.

• Execute additional responsibilities as assigned.

⛳️ Requirements

• PharmD or B.S. in Pharmacy with pertinent specialty experience.

• Registered Pharmacist with an active state license.

• A minimum of four years of experience in clinical pharmacy.

• Experience in coordinating and collaborating with work teams is preferred.

• Capability to conduct clinical reviews utilizing relevant compendia and clinical trial data.

• Experience in managed care pharmaceutical services is advantageous.

• Strong research and implementation abilities in real-world settings.

• Analytical skills with the capacity to convert findings into practical and actionable recommendations.

• Strong team-focused attitude and respect for all team members.

• Exceptional interpersonal skills, with the ability to effectively consult and collaborate with both internal and external stakeholders who do not report directly to this position.

• Strong verbal and written communication skills.

• Proficient in Microsoft Office applications and capable of quickly learning proprietary systems.

• Must be available to work evenings, weekends, or holidays as required.

• This role is remote within the United States.

🏝️ Benefits

• Flexible hours.

• Work-life balance.

• Continuous learning and career development opportunities.

• Flexible vacation policy.

• 401(k) employer match.

• Comprehensive health benefits.

• Educational assistance.

• Access to leadership and technical development academies.