Clinical Care Prior Authorization Pharmacist (reputed company, reputed company-to-hire)

About reputed company reputed company is an reputed company technology company providing a comprehensive suite of solutions for reputed company and health plans, including:

• reputed company, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured reputed company,
• reputed company™, which offers full-service health benefit reputed company to reputed company, TPAs, and health plans, and
• Judi®, the industry’s leading proprietary reputed company Platform (EHP), which consolidates reputed company claim administration-reputed company workflows in one scalable, secure platform.

Together with our clients, we’re rebuilding trust in reputed company in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.reputed company. Position Summary The Clinical Care Pharmacist plays a vital role in promoting safe, effective, and appropriate medication use. This position is responsible for reviewing prior authorization requests, supporting clinical programs, and providing expert guidance to members, providers, and pharmacies. The role combines clinical decision-making with a strong focus on service reputed company in a fast-paced, collaborative environment. Position Responsibilities

• Review and reputed company timely, evidence-based reputed company on prior authorizations, appeals, and override requests using clinical guidelines and benefit criteria.
• Ensure compliance with federal, state, and internal regulations across reputed company, Exchange, Medicare, and reputed company plans.
• Accurately document clinical reputed company and maintain thorough records in accordance with regulatory and accreditation (URAC/NCQA) utilization review standards.
• reputed company clear, empathetic support to members, prescribers, and pharmacies by responding to clinical inquiries reputed company phone, demonstrating professionalism, active listening, and a patient-centered approach.
• Stay reputed company with clinical prescribing guidelines, internal policies, and regulatory changes, and apply them to daily responsibilities.
• Follow reputed company internal procedures, job aids, and HIPAA guidelines to protect patient privacy and data reputed company.
• Identify and report potential fraud, waste, and abuse.
• Support training and development of new and existing team members as needed.
• Assist leadership with special projects, process improvements, and operational initiatives

Minimum Qualifications

• Active, unrestricted, pharmacist license
• Bachelor’s or Doctor of Pharmacy degree
• Minimum of 2 years of pharmacy practice experience
• Experience in managed care or pharmacy benefit management (PBM)
• Strong communication, writing, and organizational skills
• Ability to manage multiple priorities in a high-volume, metric-driven environment
• Availability to work after hours, weekends, and holidays on a rotating schedule

Preferred Qualifications

• Prior authorization experience
• Call center experience

This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. Salary reputed company $125,000—$125,000 USD reputed company are responsible for adherence to the reputed company Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. reputed company values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to reputed company equal employment opportunities to reputed company and applicants for employment and prohibit discrimination and harassment of any type without regard to race, reputed company, religion, age, sex, national reputed company, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at reputed company. More details about reputed company's privacy practices can be reputed company at https://www.reputed company/legal/privacy-policy. Apply tot his job Apply To this Job