Prior Authorization Pharmacist

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

📋 Description

• Assess prior authorizations for the appropriateness of medications based on established drug policy criteria.

• Deliver cost-effective, rational drug therapy and management of disease states.

• Offer customer support to health plan clients, healthcare practitioners, and members.

• Act as an educational resource for drug and clinical information for both internal and external stakeholders.

• Conduct case reviews for prior authorization requests.

• Complete peer-to-peer evaluations with healthcare professionals regarding the outcomes of prior authorizations.

• Participate as an active member of client committees as required.

• Monitor prescription turnaround times to adhere to internal standards and client performance commitments.

• Serve as a knowledge resource for team members on clinical and pharmaceutical information.

• Assist in the development of programs and process enhancements to improve customer service.

• Conduct thorough medication reviews with clear documentation of determinations.

• Proactively communicate issues or concerns to the team and the Supervisor, PA Pharmacist.

• Identify and suggest operational improvements.

• Complete additional special projects and assigned responsibilities.

⛳️ Requirements

• Possess extensive drug knowledge and the ability to accurately evaluate all drug authorization requests clinically.

• Capability to thrive in a fast-paced, high-functioning environment while meeting deadlines and managing multiple high-priority tasks.

• Proficient in personal computer use with high competency in Microsoft Word and Excel.

• Strong organizational skills with a keen attention to detail.

• Excellent oral and written communication abilities.

• Well-developed training skills.

• Comprehensive understanding of medical insurance terminology and processes.

• Exceptional critical thinking skills with a strong focus on detail.

• Outstanding customer service capabilities.

• Minimum of two years of experience as a pharmacist is preferred.

• Experience in Pharmacy Benefit Management is preferred.

• Credentialed and privileged by the company's credentialing committee.

• Willingness to obtain additional state licensure as required for the role.

• PharmD degree.

• Pharmacist license in good standing.

• Ability to sit at a desk and use a computer, telephone, and other standard office equipment.

• Must successfully pass a background screening prior to starting employment.

• Must undergo a drug screening and comply with necessary regulations on the first day of employment.

• Must comply with applicable HIPAA regulations and the company's confidentiality, privacy, and security policies.

🏝️ Benefits

• A competitive compensation package.

• Healthcare, vision, and dental insurance.

• Generous 401k matching contributions.

• Paid vacation, personal time, and holidays.

• Opportunities for growth and training.

• An award-winning remote work environment.