Prior Authorization Pharmacist

About the role:

This role serves as a reviewer of prior authorizations.

You will report into the Clinical Pharmacist Supervisor.

Responsibilities:

• Review and render decisions on authorizations and appeals for specialty, non-specialty, and physician administered drugs
• Conduct peer-to-peer calls with prescribers to discuss the clinical rationale of adverse determinations
• Participate in clinical quality audits and inter-rater reliability testing
• Provide internal team support for escalations and questions
• Apply clinical expertise to ensure appropriate and safe use of pharmaceuticals by members and providers.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 3+ years of experience as a licensed pharmacist
• 2+ years of experience performing prior authorization review in a managed care setting
• Active, unrestricted pharmacist license
• Doctor of Pharmacy Degree
• Willingness to obtain licensure/training with new states

Bonus points:

• Clinical experience applying clinical criteria in clinical review setting
• Board Certification (i.e. BCPS, BCOP)
• Residency training
• Experience practicing pharmacy in a clinical setting (i.e. retail, hospital, and specialty)