Prior Authorization Pharmacist
Location: Philadelphia, PA (Remote, EST hours required)
Client Overview
Our client is a pharmacy benefit management organization that supports health plans with prior authorization and coverage determination services. You would be joining their clinical review team, working alongside a group of pharmacists and support staff focused on making accurate, timely coverage decisions for members across the country.
Responsibilities
- Review and make determinations on prior authorization requests for pharmaceutical products
- Apply pharmacy guidelines, prior authorization criteria, and clinical judgment to medical necessity and benefit decisions
- Work independently on reviews while collaborating with senior pharmacists and supervisors as needed
- Provide clinical support to the customer care team on pharmacy related questions
- Engage with prescribers and providers to gather information supporting determinations
- Support fraud and abuse program oversight as needed
- Stay current on industry trends, regulatory changes, and operational reference materials
- Work as part of a team focused on meeting quality and performance standards
- Participate in a rotating weekend schedule if business needs require it
Requirements
- Active, unrestricted Pharmacist license
- Bachelor's degree
- Comfortable working in a Windows-based computer environment
- Able to work a Monday through Friday EST schedule, with occasional Saturday availability
Preferred Qualifications
- PharmD
- Prior authorization or coverage determination experience
- Experience in a managed care, PBM, or health plan setting
Schedule
Monday through Friday, 10:00 AM to 6:30 PM EST, with possible Saturday rotation based on business needs
About Elevait
Elevait Solutions was founded by veterans who believe that how you treat people is the only thing that actually matters in this industry. We're a team that stays in your corner before, during, and after placement. We show up for the communities we work in, we tell you the truth, and we work hard to make sure every placement is a good fit for both sides.