Prior Authorizations Pharmacist
T
The OccuNet CompanyPharmacy Benefit Management
RemoteFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- Minimum of one (1) year of direct prior authorization or utilization management experience.
- Required Skills
- Microsoft Excel
Requirements
- Bachelor of Science in Pharmacy (BSPharm) or Doctor of Pharmacy (Pharm.D.) from an accredited college.
- Active, current, and unrestricted Pharmacist license.
- Minimum of one year of direct prior authorization or utilization management experience.
- Demonstrated experience applying evidence-based clinical guidelines.
- Strong clinical knowledge of pharmacotherapy and evidence-based medicine.
- Working knowledge of the Medi-Span drug database, including GPI drug classification.
- Proficiency with Microsoft Excel, Microsoft Word, and pharmacy management systems.
- Excellent clinical judgment and critical thinking skills.
- Strong verbal and written communication skills for stakeholder interaction.
- Ability to work independently and collaboratively in a multidisciplinary team.
Responsibilities
- Review and evaluate prior authorization requests according to clinical guidelines and benefit plans.
- Complete coverage determinations within established turnaround times with high accuracy.
- Collaborate with prescribers to recommend cost-effective therapeutic alternatives.
- Coordinate the clinical review process for pharmacy benefit appeals.
- Develop and maintain clinical criteria and utilization management programs.
- Analyze pharmacy utilization data to identify prescribing trends and cost-saving opportunities.
- Provide clinical mentorship and leadership to the pharmacy operations team.
- Ensure all activities comply with HIPAA, NCQA, URAC, and federal/state regulations.
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