[Hiring] Clinical Care Prior Authorization Pharmacist @reputed company

Role Description 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.

• 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.

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

Requirements

• Prior authorization experience
• Call center experience

Salary reputed company $125,000 - $125,000 USD Company Description 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. Apply tot his job Apply To this Job