Prior Authorization Pharmacist

📋 Description

• Evaluate and make determinations on authorizations and appeals for specialty, non-specialty, and physician-administered medications.

• Engage in peer-to-peer discussions with prescribers to review the clinical justifications for adverse decisions.

• Take part in clinical quality audits and inter-rater reliability assessments.

• Offer support to the internal team for escalations and inquiries.

• Utilize clinical knowledge to ensure the safe and proper use of medications by members and healthcare providers.

• Adhere to all relevant laws and regulations.

• Perform additional duties as assigned.

⛳️ Requirements

• Minimum of 3 years of experience as a licensed pharmacist.

• At least 2 years of experience conducting prior authorization reviews in a managed care environment.

• Possession of an active and unrestricted pharmacist license.

• Doctor of Pharmacy degree required.

• Willingness to obtain licensure or training in new states.

🏝️ Benefits

• Comprehensive employee benefits.

• Participation in Oscar's unlimited vacation policy.

• Annual performance bonuses.