Clinical Pharmacist Prior Authorization

Remote, USA – Full-Time Temporary (12 months)

About the role

The Clinical Pharmacist is an operations-based role responsible for conducting clinical reviews of medical data to perform prior authorization reviews for specialty medications. Applies clinical knowledge and approved criteria to conduct prospective and concurrent reviews of cases. Collaborates with technicians and nurses to obtain appropriate clinical and medical information needed to complete clinical assessments. Communicates case decisions to physicians, health plans, employers, patients, and other healthcare professionals in accordance with established approval and denial management processes. Handles inbound calls and escalations from physicians and patients regarding pending, approved, or denied prior authorizations. Works within supported systems and maintains current knowledge of specialty medications and applicable disease states. On-call and after-hours pharmacist availability may be required.

Responsibilities

• Collaborates with technicians and nurses to process authorization requests, including answering clinical questions, collecting appropriate clinical and medical data needed to perform clinical assessments, and conducting reviews according to health plan and employer-agreed criteria within designated service level agreements — 20%
• Coordinates timely communication of case decisions to physicians, health plans, employers, patients, and other healthcare professionals following established approval and denial management processes — 15%
• Handles inbound phone calls and escalations from physicians or patients regarding prior authorization requests — 50%
• Establishes and maintains communication among health plan and employer group staff and internal stakeholders — 5%
• Maintains professional and technical knowledge of drugs and disease states for specialty medical programs — 5%
• Performs other related projects and duties as assigned, including on-call and after-hours pharmacist availability as required — 5%

Requirements

• Active pharmacist license in the state of residence in good standing
• Bachelor’s degree in Pharmacy or PharmD
• 2+ years of clinical experience with specialty medications or clinical review of prior authorization requests
• At least two years of experience as a pharmacist with prior authorization
• Ability to handle inbound phone calls and escalations related to prior authorization requests
• Excellent interpersonal and communication skills
• Experience using MS Office and other Windows-based computer applications
• Ability to maintain professional and technical knowledge of specialty medications and disease states
• Ability to work collaboratively with technicians and nurses
• Ability to communicate effectively with physicians, patients, health plans, employers, and other healthcare professionals
• Ability to meet designated service level agreements and follow established approval and denial management processes

C2C is not available. Only those lawfully authorized to work in the USA will be considered.