Prior Authorization Pharmacist – Oregon Medicaid

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

📋 Description

• Manage the Medicaid prescription drug program in accordance with state budget and legislative guidelines.

• Evaluate prior authorization requests to ensure they meet the criteria of the Preferred Drug List and clinical standards.

• Facilitate peer-to-peer consultations with providers to ensure prompt authorization decisions.

• Perform clinical assessments of medication therapies utilizing applicable compendia and clinical trial information.

• Reach out to prescribers for consultations and interventions regarding recognized prescribing anomalies.

• Analyze prior authorization data to pinpoint opportunities for intervention.

• Assist in both written and verbal communication with members and healthcare providers.

• Offer clinical insights to call center agents who manage provider and pharmacy inquiries.

• Participate in ongoing quality improvement initiatives and enhance existing processes.

• Collaborate with Medical Directors, Clinical Pharmacists, Clinical Specialty Pharmacists, product leaders, and pharmacy teams.

• Act as a subject matter expert on pharmacy-related inquiries.

• Provide clinical input during weekly updates of the drug file and suggest utilization controls.

• Aid in the operations of the Medicaid Drug Rebate Program.

• Support the state with pharmacy audits utilizing system claim information.

• Deliver continuous training to pharmacy providers.

• Generate annual reports and undertake executive administrative responsibilities for the state pharmacy program.

⛳️ Requirements

• Strong ability to communicate clearly and accurately in both written and spoken English.

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

• Experience in managed care pharmaceutical services is advantageous.

• Proficient in research and implementation skills in practical applications.

• Strong analytical abilities that can be translated into practical and actionable recommendations.

• Excellent team player with a deep respect for all colleagues.

• Consultation and collaboration capabilities with both internal and external stakeholders.

• Superb organizational, written, and oral communication skills.

• Commitment to maintaining confidentiality and adhering to HIPAA regulations.

• Highly proficient in Microsoft Office applications and quick to learn proprietary systems.

• Strong organizational skills and adept at problem resolution.

• Expertise as a pharmacist with knowledge in clinical medication therapy evaluation.

• Experience in reviewing prior authorization requests based on Preferred Drug List criteria.

🏝️ Benefits

• Flexible hours.

• Work-life balance.

• Continuous learning and career development opportunities.

• Flexible vacation policy.

• 401(k) employer match.

• Comprehensive health benefits.

• Educational assistance.

• Leadership and technical development academies.