Texas Licensed Specialty Pharmacist

Job Summary

To support utilization management activities related to specialty medications, the full-time Texas Licensed Specialty Pharmacist will perform prior authorization reviews, evaluate medical necessity, and manage clinical reviews while working remotely.

Key responsibilities

• Perform prior authorization reviews and coverage determinations for specialty medications billed under J-codes and Q-codes
• Evaluate medical necessity and adherence to clinical criteria for specialty drug requests
• Support utilization management operations and collaborate with medical and pharmacy teams to ensure alignment with health plan goals

Required qualifications

• Doctor of Pharmacy (Pharm D) degree
• Active RPh license in the state of residence
• 2 years of experience with specialty medications or prior authorization
• 1 year of experience in a PBM or Managed Care setting
• Intermediate to advanced pharmacy drug recognition skills