Texas Licensed Prior Authorization Pharmacist

Job Summary

To support a specialty infusion pharmacy, the full-time Texas Licensed Prior Authorization Pharmacist will perform comprehensive clinical reviews and manage prior authorization requests remotely, ensuring timely approvals and effective communication with Pharmacy Benefit Managers (PBMs) and health plans.

Key responsibilities

• Conduct comprehensive clinical reviews for specialty pharmacy and infusion therapy prior authorization requests
• Evaluate clinical documentation against payer-specific medical necessity criteria and coverage policies
• Communicate directly with PBMs and health plans to resolve authorization issues and mitigate denials

Required qualifications

• Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy from an accredited institution
• Active, unrestricted U.S. pharmacist license
• 2+ years of experience in prior authorization, utilization management, or managed care pharmacy operations
• Strong understanding of drug therapy, clinical guidelines, and specialty medications
• Proficiency in pharmacy benefit systems and prior authorization platforms