State Licensed Clinical Pharmacist

Job Summary

To support a growing healthcare team, the full-time State Licensed Clinical Pharmacist will conduct prior authorization reviews, evaluate medical data, and collaborate with healthcare providers remotely during designated shifts.

Key responsibilities

• Evaluate and review prior authorization requests to render coverage determinations based on clinical criteria
• Communicate case decisions to healthcare providers, health plans, and patients while adhering to approval and denial management processes
• Collaborate with the Prior Authorization team and maintain professional knowledge of drug and disease states across pharmacy programs

Required qualifications

• Bachelor's degree in pharmacy (BS Pharmacy)
• Active pharmacist license in the state of residence
• 1-3 years of prior work experience as a pharmacist
• 2 years of experience in prior authorization
• Ability to handle inbound and outbound calls and resolve escalations