State Licensed Pharmacist

Job Summary

Working remotely on a full-time temporary basis, a State Licensed Pharmacist will evaluate and review prior authorization requests, render coverage determinations based on clinical criteria, and collaborate with healthcare providers and team members to resolve escalations.

Key responsibilities

• Evaluate and review prior authorization requests and render coverage determinations based on clinical criteria and plan design
• Communicate case decisions promptly to healthcare providers, health plans, and patients in accordance with established protocols
• Collaborate with the Prior Authorization team and Member Services to answer clinical questions and obtain necessary medical information

Required qualifications

• Active pharmacist license in the state of residence
• Bachelor's degree in pharmacy (BS Pharmacy)
• 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