Prior Authorization Pharmacist
$111.78k - $146.71kOscar
Start at Oscar pharmacy. Score 25% off your first online Rx order. Hi, we're Oscar. We're hiring a Prior Authorization Pharmacist to join our Pharmacy Team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role: This role serves as a reviewer of prior authorizations. You will report into the Clinical Pharmacist Supervisor. Work Location: This is a remote position, open to candidates who reside in: Alabama; Arizona; Arkansas; Colorado; Connecticut; District of Columbia; Florida; Georgia; Idaho; Illinois; Indiana; Iowa; Kansas; Kentucky; Maine; Maryland; Massachusetts; Michigan; Minnesota; Missouri; Nevada; New Hampshire; New Jersey; New Mexico; North Carolina; Ohio; Oregon; Pennsylvania; Rhode Island; South Carolina; Tennessee; Texas; Utah; Vermont; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote Pay Transparency: The base pay for this role is: $ $111,780 -146,711.25 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities: • Review and render decisions on authorizations and appeals for specialty, non-specialty, and physician administered drugs • Conduct peer-to-peer calls with prescribers to discuss the clinical rationale of adverse determinations • Participate in clinical quality audits and inter-rater reliability testing • Provide internal team support for escalations and questions • Apply clinical expertise to ensure appropriate and safe use of pharmaceuticals by members and providers. • Compliance with all applicable laws and regulations • Other duties as assigned Requirements: • 3+ years of experience as a licensed pharmacist • 2+ years of experience performing prior authorization review in a managed care setting • Doctor of Pharmacy Degree • Willingness to obtain licensure/training with new states • Clinical experience applying clinical criteria in clinical review setting • Experience practicing pharmacy in a clinical setting (i.e. retail, hospital, and specialty) This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (View email address on click.appcast.io) to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy. We like the way you work it · no gig iddy · Gotta bag it up · no gig iddy · We like the way you work it · no gig iddy · Gotta bag it up · no gig iddy · #J-18808-Ljbffr
$35 per hour
...equivalent pharmacy technician experience. Hands-on experience with medications, prescriptions, pharmacy operations, and prior authorization workflows. Strong understanding of medication safety, drug interactions, and pharmacy best practices. Excellent written...SuggestedContract workSummer workRemote work- ...operating in the EST timezone. The position focuses on reviewing Prior Authorizations for coverage determinations within a Pharmacy Services... ...major health insurer, with approvals or denials routed to pharmacists for final review. Responsibilities include tracking requests...SuggestedRemote job
$60 - $70 per hour
...is actively recruiting several clinical Pharmacists to support a leading national health... ...decision-making process for pharmacy drug authorizations and appeals . This fully remote... ...and render clinical determinations for prior authorization and appeal requests. Conduct...SuggestedContract workTemporary workRemote workFlexible hoursShift workWeekend work$51 - $57 per hour
...Job Title: Pharmacist Location: 100% Remote across USA Estimated Length of Assignment: 11+ Months (The dates provided are only an... ...responsible for reviewing and completing criteria based on prior authorization as per policy and procedure. Experience 2 years of previous...SuggestedHourly payPermanent employmentApprenticeshipLocal areaRemote work- ...classes of drugs contraindicated in specific disease states. 5. Performs and trouble shoots order entry, claim adjudication, prior authorizations, PA appeal process, and Patient Assistance Programs. 6. Reviews patient charts and nursing medication-charting documents for...SuggestedHourly pay
- ...Actalent is actively screening for multiple remote Pharmacists to join a leading pharmacy benefits optimizer based out of Birmingham, AL. The Clinical Pharmacist reviews prior authorization and appeals, collaborates with prescribers and pharmacies, and ensures regulatory...Remote work
- ...TrueScripts Management Service is seeking a detail-oriented Prior Authorization Coordinator for a remote role. You will review and process PA requests for pharmacy claims received electronically, by fax, or from providers or members, verifying documentation and ensuring...Remote work
$55k - $60k
...rejected claim report. Contact providers/pharmacies informing formulary alternatives when available and/or how to submit Prior Authorization requests and follow up on the cases when necessary. Assist dispensing pharmacies with claim issues. Analysis and identify...$122k - $128k
...care note/assessments for supportive clinical data needed for prior authorization approvals and development of care plan recommendations.... ...interventions including but are not limited to comprehensive pharmacist consultation, motivational interviewing/coaching, drug...Work at officeLocal areaRemote work$53 per hour
Remote Clinical Pharmacist - Prior Authorizations Pay: $53.00 per hour Job Type: Remote Contract Opportunity Schedule: Flexible 8-hour shifts between 7:00 AM - 10:00 PM CST Training Schedule: Monday-Friday, 8:00 AM - 4:30 PM CST for approximately 6 weeks Location: Fully...Remote jobHourly payContract workMonday to FridayFlexible hoursShift workWeekend work$50 - $55 per hour
Actively Screening for multiple Remote - Pharmacists to join leading pharmacy benefits optimizer based out of Birmingham, AL! Job... ...Description The Clinical Pharmacist supports the review of prior authorization and appeal requests by evaluating clinical documentation and...Contract workTemporary workRemote workWork from home$130k
...more, visit Position Summary: The Utilization Management 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...Temporary workLocal areaRemote workFlexible hoursShift workWeekend work$55 per hour
...corporate and facility standard operating procedures, policies, guidelines, and work instructions. Job Responsibilities Provides prior authorization services for formulary drugs, develops programs to provide optimal pharmacy care to patients, participates in drug...Contract workRemote workWork from home$100k - $120k
...Description Job description Pharmko Staff Pharmacist Job Description Description of Job... ...before dispensing. Assures presence of authorization to dispense. Manages the use,... ...become proficient based on training § Prior authorizations, eligibilities, precise...Full timeWork from homeMonday to FridayWeekend work$52 - $66 per hour
...This is a flexible opportunity for a pharmacist interested in working 1–2 days per week... ...needs and complex medication regimens, so prior behavioral health pharmacy experience... ...Assist with medication access and prior authorizations when needed. Maintain accurate records...ReliefFlexible hours2 days per week1 day per week$135k - $145k
...Utilization Management Pharmacist Trainer Charlotte, North Carolina, United States; Denver, Colorado, United States; New York... ...provide comprehensive training sessions for pharmacists on prior authorization systems, processes, and procedures utilizing a variety of training...Work at officeLocal areaRemote workFlexible hours$22 - $25 per hour
...with physician offices regarding prescription clarifications, prior authorizations, and required documentation. Schedule patient onboarding... ...patients, providers, and internal team members. Collaborate with pharmacists, billing specialists, and other departments to ensure...Hourly payRemote work- Judi Health seeks an experienced subject matter expert in prior authorization and appeals, ensuring compliance with federal and state standards... .... You will oversee PA processes, supervision of appeal pharmacists, and staff scheduling, with a focus on performance,...
- Oscar is hiring a Clinical Pharmacist Supervisor - Prior Authorization to join our Pharmacy Utilization Management team. This role oversees a team of pharmacists performing clinical reviews for prior authorizations and appeals, driving operational excellence, and ensuring...Remote job
- ...Overview We are seeking a dedicated and detail-oriented Staff Pharmacist to join our growing independent pharmacy. The ideal... ...service and operational efficiency. Able to assist DR'S with prior authorizations Document and resolve DUR alerts through prescriber...
$45 - $55 per hour
Bring your expertise as a Clinical Pharmacist to an organization where your work makes a direct impact on patient care. In this role... ...and appropriate access to their medications by reviewing prior authorizations and supporting coverage determinations. Every decision you...Remote workWeekend work- ...Hi, we're Oscar. We're hiring a Clinical Pharmacist Supervisor - Prior Authorization to join our Pharmacy Utilization Management team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members...Full timeRemote workWork from homeHome office
- ...- UVM Medical Center is seeking an experienced ambulatory pharmacist clinician to optimize drug use in high-risk populations and... ...development, and supporting pharmacy operations including prior authorization and medication therapy outcomes. #J-18808-Ljbffr UVM Health...
- Mercor, on behalf of a leading AI research lab, seeks experienced US pharmacists to enhance AI-powered prior authorization workflows by answering medication-related questions and reviewing AI-generated responses for clinical accuracy and safety. You will annotate, provide...
- ...safe, cost-effective, and medically necessary medication use. This role combines traditional dispensing responsibilities with prior authorization review and managed care coordination. Primary Responsibilities Process and dispense prescriptions accurately in...Contract workRemote work
- ...development and growth.20. Displays willingness and flexibility to travel to other areas and locations as needs require.21. Completes prior authorizations for oral chemotherapy and supportive care medications.22. Respects and maintains confidential information. Demonstrates...Full time
- ...support retail and specialty pharmacy operations under the direction of the pharmacist-in-charge. This role will focus on accurate prescription processing and data entry, prior authorizations, billing, inventory management, and helping patients navigate pharmacy services...Monday to Friday
- Judi Health is seeking a Pharmacy Technician to support prior authorization requests and pharmacist reviews in a remote US-based role. You will validate prescriber and member information, guide reviews with clinical guidelines, and liaise with providers to gather necessary...Remote work
- ...Job Description Insight Global is looking for Prior Authorization Certified Pharmacy Technicians to work fully remote in support of one... ...management of their pharmacy insurance claims. Work closely with pharmacists and pharmacy liaisons to provide an integrated approach...Remote work
- ...organizational skills, exceptional customer service skills, and prior experience working in a fast-paced environment.... ...multitask and shift priorities, as needed Ability to process prior authorizations independently Sterile and non sterile compounding is prefered...Shift work
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