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Clinical Pharmacist (Prior Authorization)
Location
United States
Posted
6 days ago
Salary
Not specified
Seniority
Mid Level
No structured requirement data.
Job Description
Role Description
The Clinical Pharmacist (Prior Authorization) is responsible for managing the selection and utilization of pharmaceuticals and supports core clinical programs such as DUR, DIS, and formulary management.
- 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 based on medical necessity criteria.
- 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.
- Provides dosage conversion and clinical support for therapeutic interventions.
- Prepares information for network physicians.
Qualifications
- Requires BA/BS in Pharmacy.
- Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience.
- Requires a registered pharmacist.
- Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh).
- For associates working within Puerto Rico, a current PR health certificate and a current PR Law 300 certificate are required.
Requirements
- Possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh) in Indiana.
- PharmD strongly preferred.
- Must be located in a state or territory of the United States when conducting utilization review or appeals consideration.
- For URAC accredited areas, expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Benefits
- Market-competitive total rewards including merit increases.
- Paid holidays and Paid Time Off.
- Incentive bonus programs (unless covered by a collective bargaining agreement).
- Medical, dental, and vision benefits.
- Short and long-term disability benefits.
- 401(k) + match.
- Stock purchase plan.
- Life insurance.
- Wellness programs and financial education resources.
Job Requirements
- Requires BA/BS in Pharmacy.
- Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience.
- Requires a registered pharmacist.
- Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh).
- For associates working within Puerto Rico, a current PR health certificate and a current PR Law 300 certificate are required.
- Possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh) in Indiana.
- PharmD strongly preferred.
- Must be located in a state or territory of the United States when conducting utilization review or appeals consideration.
- For URAC accredited areas, expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Benefits
- Market-competitive total rewards including merit increases.
- Paid holidays and Paid Time Off.
- Incentive bonus programs (unless covered by a collective bargaining agreement).
- Medical, dental, and vision benefits.
- Short and long-term disability benefits.
- 401(k) + match.
- Stock purchase plan.
- Life insurance.
- Wellness programs and financial education resources.
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