Licensed Prior Authorization Pharmacist

Job Summary

To optimize prior authorization systems, the remote Licensed Prior Authorization Pharmacist will design and configure authorization criteria, ensure quality assurance of decision trees and templates, and collaborate with internal and external teams to improve system functionality.

Key responsibilities

• Build and review decision trees and questionnaires for prior authorization processes
• Conduct quality control and assurance validations to ensure compliance with clinical intent and regulations
• Manage relationships with external vendors and support delegated clinical prior authorization services

Required qualifications

• Active, unrestricted pharmacist license required
• 3+ years of health plan or PBM pharmacy experience required
• Strong clinical background and presentation skills required
• Proficiency in Microsoft Excel and Word, with the ability to work with structured data
• Experience supporting system testing such as UAT or configuration validation