North Carolina Licensed Prior Authorization Pharmacist

Job Summary

To support a national managed care organization, the remote North Carolina Licensed Prior Authorization Pharmacist will review prior authorization requests, provide clinical guidance to pharmacy technicians, and ensure compliance with utilization review processes on a contract basis.

Key responsibilities

• Review prior authorization requests and determine drug product eligibility based on member benefits and coverage criteria
• Track compliance of review cases and report utilization review statistics to corporate compliance committees
• Research drug information to maintain knowledge for application in prior authorization reviews

Required qualifications

• Active North Carolina Pharmacist license
• 3-5 years of experience in pharmacy benefit management (PBM), prior authorization, and managed care
• Knowledge of drug coding (NDC, GCN, GPI, USC) and NCPDP claims adjudication systems
• Experience with guideline criteria for prior authorization and non-formulary drugs
• Ability to implement quality controls and performance improvement opportunities in pharmacy practices