Prior Authorization Pharmacist

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the daily operations of the prior authorization team.

• Ensure that authorizations are obtained and reviewed accurately and promptly.

• Manage daily work queues within the PAHub prior authorization system.

• Utilize drug information resources, clinical guidelines, claims systems, and benefit design systems.

• Support the manager in supervising prior authorization technicians.

• Evaluate and either approve or deny pharmaceutical coverage based on guideline-driven prior authorization criteria.

• Collaborate with the Clinical team, Account Management, and other relevant stakeholders.

• Act as a clinical resource for other pharmacists.

• Assist in the development or revision of prior authorization criteria.

• Review prior authorizations to facilitate client member access to medications.

• Communicate approved process enhancements to the team leader.

• Take ownership of assigned tasks, prioritize responsibilities, and complete projects promptly.

• Engage in assigned projects and attend relevant meetings.

• Participate in training, research, and e-learning to stay updated on best practices and practice management technology.

• Adhere to HIPAA regulations concerning Protected Health Information.

• Report any identified HIPAA violations to the Compliance Officer and/or Human Resources.

• Complete mandatory HIPAA training and demonstrate competency.

• No travel is required.

⛳️ Requirements

• Active pharmacist license in good standing.

• Must maintain continuing education requirements.

• A BS Pharm or PharmD degree is required.

• Experience in Managed Care is essential.

• Prior authorization review experience is mandatory.

• Availability during core working hours from 8:00 AM to 5:00 PM CT.

• Capability to adjust work hours to accommodate meetings across all time zones.

• Willingness to work extended hours, weekends, and holidays as required by industry demands.

• Previous experience using PAHub is preferred.

🏝️ Benefits

• Medical, Dental, and Vision Insurance.

• Disability and Life Insurance.

• Employee Assistance Program.

• Remote Work Options.

• Generous Paid Time Off.

• Annual Reviews and Development Plans.

• Retirement Plan with company match, fully vested immediately.