Prior Authorization Clinical Pharmacist

Role Overview

• Evaluating and managing the selection and utilization of pharmaceuticals to ensure safe, effective, and cost-efficient medication use
• Supporting key clinical pharmacy programs, including Drug Utilization Review (DUR), Drug Information Services (DIS), and formulary management
• Researching and synthesizing detailed clinical data related to pharmaceuticals
• Preparing and presenting therapeutic class reviews and drug monograph information to the Pharmacy and Therapeutics Committee
• Reviewing and approving or denying coverage for pharmaceuticals (as permitted by state/federal law or state/federal program contracts) based on medical necessity criteria
• Coordinating with internal stakeholders or health plan medical directors as needed
• Serving as a clinical resource to other pharmacists

Requirements

• Requires BA/BS in Pharmacy
• Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience; or any combination of education and experience, which would provide an equivalent background
• 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 who are member or patient facing either in a clinical setting or in the Best Transportation unit, a current PR health certificate and a current PR Law 300 certificate are required for this position
• PharmD preferred
• PBM experience preferred
• Prior Authorization experience preferred
• Specialty Medication experience preferred

Benefits

• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs
• medical benefits
• dental benefits
• vision benefits
• short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources