Job Description
Role Description
- The Prior Authorization (PA) Pharmacist is responsible for reviewing prior authorization requests from providers to ensure safe and effective medication utilization. The PA Pharmacist will work with internal and external stakeholders to evaluate and continually develop strategies for Utilization Management.
- Review prior authorization requests from medical professionals to ensure alignment with Preferred Drug List (PDL) criteria and current clinical guidelines.
- Support peer-to-peer discussions with medical providers regarding prior authorization reviews.
- Collaborate on the refinement of consultation scripting; solicit and utilize input from those contacted to improve scripting.
- Contribute to the success of the Clinical Call Centers and Prior Authorization department by assisting with the implementation and management of both written and verbal communications to members and physicians.
- Serve as a resource for pharmacy-related questions and issues across the organization.
- Contribute to program improvements by using continuous quality improvement processes, proactively identifying opportunities, and providing ongoing consultation and collaboration with product leaders.
- Uphold the clinical integrity of pharmaceutical solutions by staying up to date on medication information and clinical guidelines.
- Collaborate internally with the pharmacy team (Pharmacy Manager, PDL Coordinator, Clinical Pharmacists) to identify trends or areas of opportunity.
- Perform other duties as assigned.
- Contribute creative solutions to improve the operational efficiency and effectiveness of the pharmacy team.
- Qualifications
- PharmD or B.S. in Pharmacy with relevant specialty background.
- Registered Pharmacist with an unrestricted state license (Connecticut Pharmacist License preferred but not required).
- Minimum of four (4) years of experience in clinical pharmacy.
- Strong verbal and written communication skills.
- Highly proficient in Microsoft Office products and ability to quickly learn proprietary systems.
- Requirements
- Experience coordinating and collaborating with work teams preferred.
- Ability to perform clinical reviews using relevant compendia and clinical trial data.
- Managed care and/or prior authorization experience is a plus.
- Strong research and implementation skills in practical settings.
- Analytical skills that translate into practical and pragmatic recommendations.
- Strong team orientation with respect for all members.
- Strong interpersonal skills to support effective consultation and collaboration with internal and external stakeholders who do not directly report to this role.
- Prior call center experience preferred.
- Benefits
- Generous, flexible vacation policy.
- 401(k) employer match.
- Comprehensive health benefits.
- Educational assistance.
- Leadership and technical development academies to help build your skills and capabilities.
- Work Environment
- Work from home; reliable high-speed internet connectivity is required.
- Expected working hours: 9:00 AM to 5:00 PM Eastern Time, including select holidays and occasional weekend on-call coverage.
- A dedicated, private workspace (HIPAA-compliant) with high-speed internet access is required.
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