Prior Authorization Pharmacist

LSMA Management Inc • San Bernardino, CA

2d • Remote

About The Position

The Prior Authorization Pharmacist is responsible for the clinical review of high-cost, specialty, injectable, and non-formulary medication requests within a healthcare Management Services Organization (MSO). This role ensures that coverage determinations comply with applicable federal and California regulations, evidence-based clinical guidelines, and internal policies. Working collaboratively with Medical Directors, the Pharmacy & Therapeutics (P&T) Committee, and Medical Management leadership, the PA Pharmacist validates adverse determinations, supports utilization management decisions, and serves as a clinical resource for internal and external stakeholders.

Requirements

• Doctor of Pharmacy (Pharm.D.) from an accredited college or university.
• Demonstrated clinical pharmacy experience with prior authorization review, utilization management, or managed care pharmacy functions.
• Active, current, and unrestricted Pharmacist License issued by the California State Board of Pharmacy.
• Advanced knowledge of clinical pharmacology, disease state management, and evidence-based medicine.
• Strong analytical and critical-thinking skills with the ability to exercise independent clinical judgment.
• Excellent written and verbal communication skills.
• Strong organizational skills and ability to manage competing priorities in a deadline-driven environment.
• Proficiency with electronic medical records, utilization management systems, and standard pharmacy software.
• Ability to maintain confidentiality and comply with HIPAA and regulatory requirements.

Nice To Haves

• Experience reviewing specialty, injectable, or high-cost medications within a managed care, MSO, or health plan environment.

Responsibilities

• Clinical review of high-cost, specialty, injectable, and non-formulary medication requests.
• Ensure coverage determinations comply with federal and California regulations, evidence-based clinical guidelines, and internal policies.
• Validate adverse determinations.
• Support utilization management decisions.
• Serve as a clinical resource for internal and external stakeholders.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level