Pennsylvania Licensed Pharmacist

Job Summary

To ensure timely coverage determinations, the remote Prior Authorization Pharmacist will review and process prior authorization requests while maintaining accuracy and compliance with medical necessity and regulatory guidelines.

Key Responsibilities

• Review prior authorization requests for accuracy and medical necessity
• Make coverage determinations in accordance with regulatory and plan guidelines
• Communicate decisions regarding approvals, denials, and incomplete requests to providers and patients

Required Qualifications

• Active Pharmacist license required
• 2+ years of prior authorization review experience required
• PBM, managed care, or health plan experience strongly preferred
• Strong clinical judgment and documentation skills
• Must be available to work one weekend day each week