Licensed Pharmacist Clinical Review

Job Summary

To support a remote healthcare initiative, the full-time Pharmacist Clinical Review will evaluate prior authorization requests, apply clinical knowledge for coverage determinations, and collaborate with healthcare providers while maintaining compliance with established protocols.

Key responsibilities

• Evaluate and review prior authorization requests based on clinical criteria and plan design
• Communicate case decisions to healthcare providers, patients, and health plans efficiently
• Collaborate with the Prior Authorization team and handle inbound and outbound calls to resolve escalations

Required qualifications

• Bachelor's degree in pharmacy (BS Pharmacy)
• Active pharmacist license in the state of residence
• 1-3 years of prior work experience as a pharmacist
• 2 years of experience in prior authorization
• Ability to interpret clinical guideline criteria and apply clinical knowledge appropriately