Pharmacist

Job Description

Job Title: Prior Authorization Pharmacist

Location: New York, NY

Duration: 6 months + contract ( Potential of extension)

Shift: 9:00 AM – 5:00 PM | 7 Hours/Day | 35 Hours/Week

Schedule Notes:

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• Days: Monday–Friday ( 2 Days onsite - 3 days remote)
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• Work Schedule: Full-time hours
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• Work Location: Hybrid
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Purpose of Position:

The Prior Authorization Pharmacist is responsible for rendering decisions for prior authorization requests utilizing clinical judgement and internal criteria. The Pharmacist is also responsible for improving patient care through medication reconciliation, counseling and care management.

Product of Role & Responsibilities:

• Reviews Medical drug prior authorization and appeal requests for all LOBs then renders coverage determinations based on preferred drug strategies, available benefits, internal criteria and clinical judgement

• Assists in responding to internal/external inquiries related to prior authorization review including weekends and holidays

• Assists in identifying inappropriate utilization during claims and prior authorization review

• Performs audits as necessary of vendor or internal reviewed cases to ensure all clinical, organizational and operational standards have been met

• Completes medication reviews for members to ensure safe and efficacious therapy

• Assists in organizational and departmental quality improvement initiatives

• Responds to pharmacy benefit related inquiries

• Participates in Quarterly Pharmacy and Therapeutics (P&T) meetings

• Creates and reviews prior authorization criteria for medications as needed

Required Education, Training & Professional Experience:

• Doctor of Pharmacy required

• Clinical pharmacy experience and utilization management experience in a managed care environment preferred

• Experience in Pharmacy management of government programs (Medicaid and Exchange) preferred

• Proficiency with MS Word, Excel, and PowerPoint is required. Experience in the evaluation and interpretation of pharmacy claims data and other clinical data is preferred

• Position requires excellent organizational, teamwork, interpersonal, time management, written and verbal communication skills

Licensure and/or Certification Required:

• Current New York State Pharmacy License (active and not limited).