Review prior authorization requests for medications
Develop clinical criteria and medical policies for medications
Conduct prior authorization reviews in compliance with CMS and NYSDOH guidelines
Research drug information and maintain drug knowledge for reviews
Review monthly reports and provide feedback on trends and efficiency

Pharmacy degree from an accredited school of pharmacy
Registered Pharmacist in the state of New York with a license in good standing
Minimum of 1 year experience conducting prior authorization reviews
Strong clinical knowledge of pharmaceuticals and disease states in order to conduct prior authorization reviews
Strong clinical writing and verbal skills
Demonstrated critical thinking and problem-solving skills
Knowledge of specialty pharmaceuticals and billing practices in the medical and pharmacy benefits

Clinical Pharmacist

Key skills