Prior Authorization Pharmacist

Oscar Health

2d•Remote

About The Position

This role serves as a reviewer of prior authorizations. You will report into the Clinical Pharmacist Supervisor. This is a remote position, open to candidates who reside in: Alabama; Arizona; Arkansas; Colorado; Connecticut; District of Columbia; Florida; Georgia; Idaho; Illinois; Indiana; Iowa; Kansas; Kentucky; Maine; Maryland; Massachusetts; Michigan; Minnesota; Missouri; Nevada; New Hampshire; New Jersey; New Mexico; North Carolina; Ohio; Oregon; Pennsylvania; Rhode Island; South Carolina; Tennessee; Texas; Utah; Vermont; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. The base pay for this role is: $ $111,780 -146,711.25 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

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

Nice To Haves

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)

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