Prior Authorization Clinical Pharmacist
Anticipated End Date
Position Title
Virtual
The Prior Authorization Clinical Pharmacist
How you will make an impact
- Researches and synthesizes detailed clinical data related to pharmaceuticals.
- Prepares and presents therapeutic class reviews and drug monograph information to the Pharmacy and Therapeutics Committee.
- May review and approve or deny coverage for pharmaceuticals (as permitted by state/federal law or state/federal program contracts) based on medical necessity criteria, and coordinates with internal stakeholders or health plan medical directors as needed.
- Serves as a clinical resource to other pharmacists on areas such as prospective, inpatient and retrospective DURs and provides dosage conversion and clinical support for therapeutic interventions.
- Prepares information for network physicians.
- Prepares and presents therapeutic class reviews and drug monographs to the Pharmacy and Therapeutics (P&T) Committee.
- Provides clinical guidance for therapeutic interventions, dosage conversions, and evidence-based medication use.
- Develops and communicates drug information and recommendations to network physicians and clinical teams.
Minimum Requirements
- Requires BA/BS in Pharmacy.
- Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience; or any combination of education and experience, which would provide an equivalent background.
- Requires a registered pharmacist.
- Current unrestricted Pharmacist license in applicable state(s) required.
- For associates working within Puerto Rico who are member or patient facing either in a clinical setting or in the Best Transportation unit, a current PR health certificate and a current PR Law 300 certificate are required for this position.
Preferred Skills, Capabilities and Experiences
- Active, unrestricted license to practice pharmacy as a Registered Pharmacist (RPh) in the states of Kansas, North Carolina, and/or Washington
highly preferred.
- PharmD preferred.
- PBM experience preferred.
- Prior Authorization experience preferred.
- Specialty Medication experience preferred.
Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US, unless they are command-sanctioned activities.
For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
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NOTE
Not included in the source posting: what you'll do, benefits.
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