Clinical PA Pharmacist - Coverage & Decisions

IntePros; Philadelphia (Philadelphia County); On-site; USD 110,000 - 140,000; Full time

Job summary

IntePros, in Philadelphia, seeks a licensed Pharmacist to join the Prior Authorization team, reviewing requests and making medical necessity and coverage decisions per guidelines and regulatory requirements.

The role emphasizes independent clinical reviews while collaborating with senior pharmacists and the broader pharmacy team to meet quality and turnaround-time standards, and to support the Customer Care Center with clinical inquiries.

Qualifications

• Current, active Pharmacist license required.
• Bachelor's degree in Pharmacy required; PharmD preferred.
• Prior professional pharmacist experience is not required.
• Prior experience with prior authorization, pharmacy benefit management, utilization management, or coverage determinations is preferred.

Responsibilities

• Review and evaluate prior authorization requests for pharmaceutical products.
• Make clinical determinations regarding medical necessity and benefit coverage.
• Apply independent clinical judgment when reviewing member-specific information.
• Communicate with prescribing providers to obtain additional clinical information.
• Provide clinical support to the Customer Care Center regarding medication coverage and PA requirements.
• Collaborate with senior pharmacists and internal teams on complex cases.
• Support fraud, waste, and abuse monitoring as appropriate.
• Maintain knowledge of pharmacy guidelines, new therapies, and regulatory changes.
• Maintain accurate documentation of clinical reviews and determinations.
• Meet established quality, productivity, accuracy, and turnaround-time expectations.

Education

Bachelor's degree in Pharmacy

PharmD preferred

Job description

IntePros, in Philadelphia, seeks a licensed Pharmacist to join the Prior Authorization team, reviewing requests and making medical necessity and coverage decisions per guidelines and regulatory requirements.

The role emphasizes independent clinical reviews while collaborating with senior pharmacists and the broader pharmacy team to meet quality and turnaround-time standards, and to support the Customer Care Center with clinical inquiries.