Texas Licensed Prior Authorization Pharmacist

Job Summary

To support a respected healthcare organization, the full-time Texas Licensed Prior Authorization Pharmacist will review prior authorization requests, verify coverage, and communicate determinations while working remotely.

Key responsibilities

• Review prior authorization requests and make coverage determinations based on clinical criteria and plan design
• Communicate approvals and denials to providers, members, and stakeholders in a timely manner
• Collaborate with the prior authorization team to gather necessary documentation and resolve escalations

Required qualifications

• Active Pharmacist license applicable to the role must be included at the top of the resume
• Prior authorization experience strongly preferred, ideally with 2+ years in the field
• Experience in PBM, Managed Care, or Health Plans is strongly preferred; Specialty Pharmacy experience is a plus
• High school diploma or GED verifiable
• Comfortable handling high call volumes, approximately 50 calls and 40 PA cases per day