Prior Authorization Pharmacist

Job Summary

To support high-quality pharmaceutical care, the full-time Prior Authorization Pharmacist will conduct clinical reviews of pharmacy prior authorization requests, ensuring compliance with member benefits and clinical guidelines while working remotely.

Key responsibilities

• Review and evaluate prior authorization requests in accordance with clinical guidelines and client policies
• Coordinate clinical reviews of appeals and communicate coverage decisions to stakeholders
• Assist in the development and maintenance of prior authorization criteria and clinical guidelines

Required qualifications

• Bachelor of Science in Pharmacy (BSPharm) or Doctor of Pharmacy (Pharm.D.) degree from an accredited college of pharmacy
• Active, current, and unrestricted Pharmacist license
• Minimum of one (1) year of direct prior authorization or utilization management experience
• Experience applying evidence-based clinical guidelines in pharmacy practice
• Knowledge of pharmacy benefit management operations and utilization management principles