Prior Authorization Pharmacist Jobs

About The Position

Requirements

• A minimum of a bachelor’s degree in Pharmacy or a PharmD.
• Current, unrestricted Registered Pharmacist license in the state of residence, or ability to gain reciprocity within four months where required by state law or client contract; other state pharmacy licenses may be required based on business needs.
• Maintain continuing education credits required to keep licensure active.
• Exceptional clinical skills and ability to apply sound clinical judgment to a variety of situations.
• Ability to reason and translate clinical information for clinical systems and clinical and non-clinical audiences.
• Problem-solving skills, including identifying and accepting challenging situations and creating and implementing solutions.
• Attention to detail to ensure projects are clinically, editorially, and systems accurate and operationalizable.
• Ability to interact cooperatively and respectfully with other employees.

Nice To Haves

• Two years’ work experience in a clinical setting, or a clinical or managed care pharmacy practice residency (preferred).
• Knowledge of the PBM industry, formulary management, pharmacy claims, and managed care principles and practices (desired).
• Proficiency in drug literature and clinical trial evaluation, including electronic databases such as Micromedex, Medline, and the Internet (preferred).
• Proficiency in Microsoft Word, Excel, and PowerPoint, including tables, charts, and figures (preferred).

Responsibilities

• Perform prior authorizations and duties related to concurrent, retrospective, and prospective Drug Utilization Review.
• Support Customer Care with clinical calls requiring pharmacist intervention.
• Interface with physicians, pharmacists, and specialty pharmacy providers regarding beneficiaries’ benefits and therapeutic interventions.
• Review and evaluate health surveys and utilization data for program management and development.
• Support and provide input to Health Management, Drug Utilization Review, formulary development, and Prior Authorization programs to encourage appropriate, high-quality, cost-effective drug therapy and identify opportunities to improve program efficiency, accuracy, and appropriateness.
• Participate in the Coverage Determination process by reviewing requests that are not clearly approvable based on specified criteria, making coverage denial determinations, and identifying themselves by first name, title, and responsibility at Navitus in relation to drug utilization management program administration.
• Monitor the quality and efficiency of the Coverage Determination process, including coverage criteria, denial language, and communication with prescribers.
• Provide input to the clinical content of new programs and maintenance of existing programs.
• Complete all annual URAC training requirements.
• Facilitate communication and education for clients, members, and internal staff regarding clinical daily issues and objectives.
• Support operational departments with implementation of PBM programs and daily operations in support of member and patient quality of care.
• Provide clinical expertise related to formulary decisions made by the Pharmacy and Therapeutics committee.
• May review health care survey data for Medicare Part D qualified participants, conduct phone consultations with Med-D enrollees, help document calls, and designate enrollees for repeat interaction.
• Perform other duties as assigned.
• Participate in, adhere to, and support compliance program objectives.

Benefits

• Health insurance
• Dental insurance
• Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401(k) company match of up to 5%, with no vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan
• Professional Membership assistance
• Referral Bonus Program of up to $750