Clinical Pharmacist - Prior Authorization
About The Position
The Clinical Pharmacist (Prior Authorization) manages the selection and utilization of pharmaceuticals and supports core clinical programs, including drug utilization review (DUR), drug information services (DIS), and formulary management. The role researches and synthesizes detailed clinical pharmaceutical data; prepares and presents therapeutic class reviews and drug monograph information to the Pharmacy and Therapeutics Committee; and may review and approve or deny pharmaceutical coverage based on medical necessity criteria, as permitted by applicable law and program contracts. The pharmacist coordinates with internal stakeholders or health plan medical directors as needed, serves as a clinical resource to other pharmacists, and prepares information for network physicians. This role is virtual eligible and allows full-time virtual work, except for required in-person training sessions. Candidates must live within a reasonable commuting distance of an office, unless an accommodation is granted as required by law. The position follows general business hours, Monday through Friday. Candidates must hold an active, unrestricted pharmacist license and be licensed in Kansas or North Carolina.
Requirements
- Bachelor of Arts or Bachelor of Science in Pharmacy.
- At least 2 years of managed care pharmacy (PBM) experience, or a residency in lieu of work experience, or an equivalent combination of education and experience.
- Registered pharmacist.
- Active, unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh).
- Must be licensed in Kansas or North Carolina.
- For associates in Puerto Rico who are member- or patient-facing in a clinical setting or in the Best Transportation unit: current Puerto Rico health certificate and current Puerto Rico Law 300 certificate.
- Strong oral, written, and interpersonal communication skills.
- Problem-solving, facilitation, and analytical skills.
Nice To Haves
- PharmD, very strongly preferred.
Responsibilities
- Research and synthesize detailed clinical data related to pharmaceuticals.
- Prepare and present therapeutic class reviews and drug monograph information to the Pharmacy and Therapeutics Committee.
- As permitted by applicable state or federal law and program contracts, review and approve or deny pharmaceutical coverage based on medical necessity criteria.
- Coordinate with internal stakeholders or health plan medical directors as needed.
- Provide clinical support to other pharmacists on prospective, inpatient, and retrospective drug utilization reviews (DURs).
- Provide dosage conversion and clinical support for therapeutic interventions.
- Prepare information for network physicians.
Benefits
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs, unless covered by a collective bargaining agreement
- Medical benefits
- Dental insurance
- Vision insurance
- Short- and long-term disability benefits
- 401(k) with matching
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
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What This Job Offers
Job Type
Full-time
