Prior Authorization Pharmacist

To support high-quality pharmaceutical care, the full-time Prior Authorization Pharmacist will conduct clinical reviews of pharmacy prior authorization requests, ensuring compliance with member benefits and clinical guidelines while working remotely. Key responsibilities Review and evaluate prior authorization requests in accordance with clinical guidelines and client policies Coordinate clinical reviews of appeals and communicate coverage decisions to stakeholders Assist in the development and maintenance of prior authorization criteria and clinical guidelines Required qualifications Bachelor of Science in Pharmacy (BSPharm) or Doctor of Pharmacy (Pharm.D.) degree from an accredited college of pharmacy Active, current, and unrestricted Pharmacist license Minimum of one (1) year of direct prior authorization or utilization management experience Experience applying evidence-based clinical guidelines in pharmacy practice Knowledge of pharmacy benefit management operations and utilization management principles