Senior Operations Pharmacist

Job Summary

Seeking a motivated Senior Clinical Review Operations Pharmacist to work remotely in a full-time capacity, focusing on maintaining high-quality clinical reviews, optimizing processes and technology, mentoring peer pharmacists, and driving cross-functional collaboration within the Prior Authorization team.

Key responsibilities:

• Identify operational process gaps and implement technology-driven solutions to enhance efficiency
• Provide guidance and mentorship to fellow pharmacists, ensuring clinical consistency and quality
• Act as a senior contact for complex clinical cases, escalated coverage determinations, and appeals

Required qualifications:

• 5+ years of experience in health plan or Pharmacy Benefit Manager (PBM) operations, specifically in prior authorization review
• Active and unrestricted Pharmacist License required
• Bachelor's degree in Pharmacy or Doctor of Pharmacy (PharmD) required
• Demonstrated expertise in driving process improvements and technology efficiencies
• Strong proficiency with Mac, MS Office, and G-Suite platforms