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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, strong oral, written, and interpersonal communication skills are expected.
• Problem-solving, facilitation, and analytical skills are also required.

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) with company match.
• Stock purchase plan and life insurance.
• Wellness programs and financial education resources.