Prior Authorization Pharmacist
Job Summary
The Prior Authorization Pharmacist serves as a reviewer of authorization requests and appeals for various drug categories. This remote role involves conducting peer-to-peer calls with prescribers to discuss clinical rationales for adverse determinations. The position requires applying clinical expertise to ensure safe pharmaceutical use while maintaining compliance with regulations.
Responsibilities
- Review and decide on drug authorizations and appeals
- Conduct peer-to-peer discussions with prescribers
- Participate in clinical quality audits and reliability testing
- Provide clinical support for escalations
Required Skills
- 3+ years as a licensed pharmacist
- 2+ years in managed care prior authorization
- Doctor of Pharmacy Degree
- Active, unrestricted pharmacist license
Job Details
Responsibilities:
- Review and render decisions on authorizations and appeals for specialty, non-specialty, and physician administered drugs.
- Conduct peer-to-peer calls with prescribers to discuss the clinical rationale of adverse determinations.
- Participate in clinical quality audits and inter-rater reliability testing.
- Provide internal team support for escalations and questions.
- Apply clinical expertise to ensure appropriate and safe use of pharmaceuticals by members and providers.
- Compliance with all applicable laws and regulations.
- Other duties as assigned.
Requirements:
- 3+ years of experience as a licensed pharmacist.
- 2+ years of experience performing prior authorization review in a managed care setting.
- Active, unrestricted pharmacist license.
- Doctor of Pharmacy Degree.
- Willingness to obtain licensure/training with new states.
Bonus points:
- Clinical experience applying clinical criteria in clinical review setting.
- Board Certification (i.e. BCPS, BCOP).
- Residency training.
- Experience practicing pharmacy in a clinical setting (i.e. retail, hospital, and specialty).