Clinical Pharmacist - Prior Authorization
Varite Inc
Duration: 6 months contract
The clinical pharmacist is an operation based role that conducts clinical reviews of medical data collected to perform prior authorization for specialty medications. The clinical pharmacist will apply clinical knowledge to plan approved criteria for prospective and concurrent reviews of cases. This role will work for supported systems and take inbound calls from physicians or members regarding their pending, approved, or denied prior authorizations.
Comply with CMS mandated timelines and department productivity and quality standards.
Acquire and utilize clinical judgement and knowledge, drug compendia resources, relevant and changing work instructions, and CMS Medicare guidance.
Collaborates with the CRU Technician to process referrals, including answering clinical questions, collecting appropriate clinical/ medical data needed to perform clinical assessments, and reviews as per the health plan/employer agreed criteria within the designated service level agreements.
Coordinates timely communication of case decision to physician, health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes.
Handles inbound phone calls and escalations from physicians or patients regarding Prior Authorization
Establishes and maintains communication among, health plan and employer group staff.
Maintain professional and technical knowledge of drug and disease-states for the Specialty Pharmacy programs administered within the Case Review Unit.
Performs other related projects and duties as assigned including on call and after hours pharmacist availability could be required.
Prior authorization experience preferred.
Previous pharmacy experience in retail or hospital preferred.
Prior Authorization
Bachelor's Degree Required, Pharm D Preferred.
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
All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
- ...: The Ohio Department of Medicaid (ODM) is seeking a Pharmacist to be a part of its Pharmacy unit. As a member of the Medicaid... ...in the Ohio Medicaid Program, including development of prior authorization criteria Assisting in the management of the Medicaid Pharmacy...SuggestedFull timePart timeWork at office
- ...also meet departmental staff development requirements. The pharmacist may participate in departmental or health system committees... ...safety, appropriateness, and clinical efficacy d. Completes prior authorizations/appeals for medications using EMR data and/or direct...SuggestedReliefInternshipWork at officeShift work
- ...Staff Pharmacist – Independent Pharmacy & Primary Care Services Benson, NC | Full-Time | Monday–Friday | No Weekends About... ...Assist patients with medication affordability programs and prior authorization support. Promote medication adherence through patient engagement...SuggestedFull timeTemporary workWork at officeRemote workMonday to Friday
- ...seamless integration for patient enrollment, consent, and prior authorization. Our best-in-class patient support services enhance every step... ...and accelerate time-to-therapy. JOB TITLE: Staff Pharmacist - Non-Commercial Pharmacy POSITION SUMMARY: The Staff...Suggested
- ...Pharmacist Opportunity Soliant is seeking a driven and motivated pharmacist for a contract-to-hire opportunity with a specialty... ..., and reimbursement specialists. Assist with prior authorizations, insurance navigation, and financial assistance programs....SuggestedContract workImmediate startMonday to Friday
- ...NPS Pharmacy Staff Pharmacist Ranked one of Tennessee's top places to work, MHC is a rare and special place where outstanding... ...within pharmacist scope. Assist with refill coordination, prior authorization support, rejection troubleshooting, and provider...Temporary workMonday to FridayShift workWeekend workWeekday work
- ...work independently while maintaining close collaboration with pharmacists and healthcare providers. Roles and responsibilities... ...coordination, and delivery logistics Manages and tracks prior authorization (PA) submissions, follow-ups, approvals, and denials Coordinates...Contract workWork at officeLocal area
- ...ITAC Solutions is seeking a Pharmacy Technician (CPhT or ExCPT) for a fully remote role that supports prior authorization decisions. You will review requests, verify required clinical information, and serve as the primary contact for members, pharmacies, and provider offices...Remote work
$91.7k - $163.7k
...behind Caring. Connecting. Growing together. As a Specialty Pharmacist you will provide high-touch support to patients with... ...manufacturers to ensure therapy access and continuityOversee prior authorizations and utilization management, ensuring compliance with payer...Minimum wageFull timeWork experience placementWork at officeLocal area- ...a rewarding position at Grady!SUMMARYMedication Adherence Pharmacists work closely with retail pharmacy colleagues, providers, patients... ...Management (MTM). Document MTM activities. Complete prior authorizations. Oversee Medication Access Coordinators assigned to complete...
- This Pharmacist position will function as an enterprise project manager for HVPE. The focus of this role is on enterprise level project... ...work. This includes consolidation and standardization of prior authorization workflows and centralized patient communication and call...Full timeTraineeship
- ...Days (United States of America)Job Summary:This position will work remotely to support clinic and pharmacy locations, alongside Prior Authorization Billing Specialists.Reviews and supports prior authorizations, formulary exception requests, payer denials and appeals, and...Full timeRemote workFlexible hours
- ...benefit program for Comanche County Hospital Authority's self-insured health plan. This position requires a licensed pharmacist who will optimize medication therapy outcomes... ...HIPAA, and healthcare regulatory requirements. Prior retail experience. Current Oklahoma Pharmacy...
$32 - $43.07 per hour
...pharmacy services by working collaboratively with ambulatory care pharmacists and clinic teams to assist with patient outreach,... ...pharmacy coordination, scheduling, program participation, prior authorization status, and follow-up needs. Maintains program trackers,...Hourly payWork experience placementShift work$21.7 - $32.55 per hour
...employees perform various services and duties, including pharmacy administration, pharmacy primary care services, medication prior authorization, sterile and non-sterile compounding, unit dose packaging, and specialty/mail service program. Job Description UW Hospital...Temporary workWork experience placementMonday to FridayShift workDay shift$80.22 per hour
Join our team as a Per Diem Pharmacist at Salud Medical Center in Woodburn, OR, and be part of a healthcare organization... ...support to medical providers via chronic refill authorization, therapeutic interchanges, and prior authorization completions. Additionally, there is an...Daily paidWork experience placementMonday to FridayShift work- ...Certified Pharmacy Technician – Prior Authorization Location: Dallas–Fort Worth, TX Work Arrangement: 100% Onsite Schedule: Full-time, 8.5-hour shift scheduled between 8:30 a.m. and 7:00 p.m. CST Help Patients Access the Medications They Need Cloud Rx...Full timeShift work
- ...health conditions requiring follow‑up to a pharmacist Utilize case management and pharmacy... .... Complete any REMS forms and authorizations required from the pharmacy. Print drug‑... ...medications for patients by completing Prior Authorization Requests, co‑pay assistance...Full timeLocal areaRelocation packageDay shift
- ...projects to enhance pharmacy operations. Collaborates with pharmacists and healthcare teams to improve patient care and recruitment... ...at pickup. • Processes insurance claims, completes prior authorizations, and manages billing. • Maintains medication inventory, storage...Part timeWork experience placementReliefInternshipRemote workFlexible hoursShift work
- ...invent new ways of working in an industry that historically has resisted innovation. Join us!We are looking for you to join our Prior Authorization team to raise the bar on our customer service we provide to our patients and partners. This is your opportunity to join a...Shift work
- ...Specialty Pharmacist Location: Outpatient Pharmacy, Coldwater, MI Schedule: Full-Time, Days Job Summary: Provides pharmacy... ...care. Assists with medication access activities, including prior authorization support, appeals, financial assistance programs, and...Full timeLocal area
- ...Pharmacist Our company, Apotheco Pharmacy, is searching for a pharmacist. The pharmacist will oversee and provide direction related... ...when applicable for refills, medication changes, and prior authorizations. 13. Making sure all drugs have a minimum of 6 months prior...Daily paidPart timeRemote workMonday to Friday
- ...Fully remote (never coming onsite) Position Summary The Pharmacist/Clinician is an operation-based role that conducts criteria... ...& clinical review of medical data collected to perform prior authorization as per policy and procedure. The Pharmacist/Clinician will...Work experience placementRemote workShift workWeekend work1 day per week
$50.48 - $84.62 per hour
...details in required qualifications Exciting opportunity for a Pharmacist to join our Specialty Mail Service Pharmacy located in... ...healthcare providers and insurance companies to obtain prior authorizations and facilitate reimbursement for specialty medications....Hourly payFull timeTemporary workWork experience placementWork at officeLocal areaWork from homeMonday to FridayShift work$55 per hour
...Pharmacist (100% Remote) Long-term Opportunity | Open to (nearly) ALL States | PBM Description Candidates will be reviewing... ...Management (UM) requests (i.e., formulary exceptions, prior authorization, step therapy, quantity limit exceptions). Client-specific...Contract workTemporary workRemote work- ...Prior Authorization Pharmacist Market leading national healthcare organization is hiring prior authorization pharmacists for a remote role! Great opportunity! Training: M-F 8-4:30PM CST for 6 weeks*Possible weekend shifts* Position Summary: The clinical pharmacist...Remote workShift workWeekend work
$73.6k - $147.29k
...everywhere. Apply today! Job Details The Speciality Pharmacist Navigator position seeks relationships with physicians and... ...adjudication and product sourcing. Prepare and submit prior authorization paperwork; manage denials. Triage prescriptions which...Full timeWork at officeLocal area- ...Remote Case Management Pharmacist Coordinate care for complex patients | Work from home support high-risk and complex patients... ...adherence concerns, or potential interactions. Support prior-authorization and appeals processes when needed. Educate patients and...Remote work
- ...Job Title: Pharmacist Location: Remote Duration: 12+ months contract Job Description: ~ As an RPh Advisor you will... ...in progress and provides a Clinical decision regarding Prior Authorizations, Tier Exceptions and Non-Formulary requests (50%) Performs...Contract workRemote work
- ...Remote, TX Contract Job Title: Prior Authorization Pharmacist Location:Remote Duration: 6+ months contract Job Description: ~ Responsible for reviewing and completing criteria based on prior authorization as per policy and procedure. Responsibilities...Contract workRemote work
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Clinical Pharmacist - Prior Authorization. Be the first to apply!
- hospital pharmacist United States
- clinical pharmacist United States
- medical prior authorization specialist United States
- remote prior authorization pharmacist United States
- prior authorization coordinator United States
- prior authorization nurse work from home United States
- remote prior authorization United States
- prior authorization specialist United States
- prior authorization United States
- prior authorization nurse United States




