Pharmacist

Prior Authorization Pharmacist

Duration: 03 months with possible extension

Summary: The Prior Authorization Pharmacist reviews pharmaceutical coverage requests and determines medical necessity and benefit eligibility based on clinical guidelines and regulatory requirements. Responsibilities include supporting customer care, communicating with healthcare providers, and ensuring quality and compliance in coverage decisions. Requires a current pharmacist license, a bachelor's degree in pharmacy, and proficiency in Windows-based systems. Prior authorization experience is preferred but not required.

Responsibilities

As a licensed healthcare professional employed in the Prior Authorization Department the primary responsibility of Pharmacist (R) is to make determinations on prior authorization requests for coverage of pharmaceutical products.

Determinations include medical necessity and benefit decisions. Decisions are made in accordance with established pharmacy guidelines, prior authorization criteria, industry regulations and sound clinical judgment.

Prior Authorization Pharmacist (R) works independently with respect to reviews and decision making, with the support of Pharmacist II (R)s and supervisors.

Pharmacist (R) works as a member of a team of peers committed to meeting or exceeding quality standards and customer performance guarantees. This position includes a rotating weekend schedule if business needs dictate.

Additional responsibilities include:

• Provide clinical support to the client Customer Care Center
• Engage providers in discussions to support determinations
• Support Fraud and Abuse program oversight
• Keep abreast of industry trends and regulatory changes
• Keep abreast of operational directives and customer reference materials

Experience

5+ years of experience.

Education

Bachelor's Degree, PharmD preferred

Current Pharmacist license

Required Skills

Windows environment proficiency

Prior authorization

Coverage determination

PC skills

About US Tech Solutions

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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