Key Responsibilities:
- Review and process prior authorization requests based on clinical criteria and member benefits.
- Coordinate drug utilization review reports and ensure compliance with regulatory requirements.
- Handle clinical calls from Customer Care for medication-related prior authorizations.
- Manage PA appeals and ensure adherence to policies and procedures.
- Act as a clinical resource for internal teams, prescribers, and clients.
- Monitor and improve the quality and efficiency of the Coverage Determination process.
- Stay updated on clinical guidelines and provide relevant insights for program development.
- Supervise the Prior Authorization Department, ensuring operational efficiency and training.
- Develop and implement departmental protocols and training materials.
Qualifications:
- Doctor of Pharmacy (PharmD) with at least 2 years of experience and licensed in the state of practice.
- Prior experience with prior authorizations, clinical pharmacy, and managed care is preferred.
- Knowledge of PBM, formulary management, and 340B is a plus.
Why Work for Us?
We offer competitive pay, paid holidays, benefits, paid time off and a work/life balance. Not only that, but we also offer paid parental leave, recognition programs, promotion opportunities, a comprehensive training program to enhance your career, and employee prescription discounts.
