Clinical Pharmacist

LucyRx Health Solutions, Inc.; United States; Hybrid; USD 85,000 - 99,000; Full time

Job summary

LucyRx Health Solutions, Inc. is seeking a Clinical Pharmacist to conduct clinical reviews of prior authorization requests, ensuring evidence-based determinations and regulatory compliance.

The role supports timely patient access while maintaining documentation quality and clear communication with providers. Responsibilities include reviewing PA requests, evaluating documentation, applying clinical criteria, and escalating complex cases per protocols.

Qualifications

• Must have Doctor of Pharmacy or BS Pharmacy with equivalent experience.
• Active pharmacist license in good standing in any US state.
• Minimum 2 years of PBM or health plan experience.
• Current clinical prior authorization review experience.

Responsibilities

• Review and process PA requests using clinical guidelines and criteria.
• Evaluate documentation for completeness and appropriateness.
• Apply evidence-based decisions and document rationale.
• Communicate PA outcomes with providers and prescribers.
• Escalate complex cases per protocols.
• Ensure HIPAA compliance and PHI handling.
• Support appeals and quality assurance initiatives.

Skills

Clinical review

Documentation

Communication

HIPAA compliance

Attention to detail

Education

Doctor of Pharmacy

BS Pharmacy with equivalent experience

Active pharmacist license

Tools

PA Hub

UpToDate

Lexicomp

Microsoft Office

Job description

It's fun to work in a company where people truly BELIEVE in what they're doing! We're committed to bringing passion and customer focus to the business.

The Clinical Pharmacist is responsible for conducting clinical reviews of prior authorization requests, ensuring that all determinations are evidence-based, compliant with regulatory standards, and aligned with clinical criteria. This role supports timely patient access to appropriate therapies while maintaining high standards of documentation, communication, and quality assurance.

Role and Responsibilities

• Review and process medication prior authorization (PA) requests using clinical guidelines, compendia, and clinical criteria.
• Evaluate submitted documentation (diagnosis, labs, previous therapies) for completeness and appropriateness.
• Apply evidence-based clinical decision‑making to approve or deny PA requests, documenting rationale clearly and concisely.
• Communicate with providers, prescribers, etc. regarding PA outcomes, additional information needs, or clarifications.
• Escalate complex or medical exception cases according to established protocols.
• Utilize internal platforms (e.g., PA Hub), formulary and criteria tools, and drug information resources (e.g., UpToDate/Lexicomp).
• Ensure compliance with HIPAA, PHI handling, and all regulatory requirements.
• Participate in quality assurance activities
• Support appeals, peer‑to‑peer reviews, and contribute to process improvement initiatives.
• Maintain up-to‑date knowledge of formulary changes, clinical guidelines, and regulatory updates.
• Participate in meetings, team training and professional development of prior authorization processing, appeals, and any related clinical services issues.
• Assist with clinical program operations and special projects as required according to business needs.

Qualifications and Education Requirements

• Requires a Doctor of Pharmacy or a BS, Pharmacy with equivalent experience
• Active pharmacist license, in good standing, in any US state
• Minimum of 2 years of experience in a PBM or health plan
• Current clinical prior authorization review experience for managed care organizations.

Knowledge and Skills Required

• Proficiency with Microsoft Office suite
• Excellent organizational, written and verbal communication
• Highly motivated and good interpersonal skills, self-starter
• Excellent critical thinking skills, detail‑oriented
• Ability to adapt and perform duties efficiently whenever unexpected changes arise
• Works well in a fast‑paced environment
• Knowledge of HIPAA regulations

PHYSICAL REQUIREMENTS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. This is a largely sedentary role; however, some standing, walking, bending, and reaching may be required. Regularly operates in an office or home office setting which involves utilizing a computer, mouse, keyboard, and occasionally operating other standard office equipment, such as printer, copier, phone. Travel may be required by either car or airplane, or a combination of multiple modes of transportation.

Salary $84,800- $99,376

Careers At LucyRx, you won’t just have a job, you’ll have a purpose. As a luminary—a person who inspires, influences, and lights the way forward—you’ll be part of a team reimagining what’s possible in pharmacy benefits. Join a team that’s leading the charge toward a more transparent, accountable, and people‑first approach to prescription benefits. If you’re ready to challenge the status quo and illuminate a better path forward, you’re in the right place.