Clinical - Pharmacist 1

Pyramid Consulting Healthcare; Austin (TX); On-site; USD 80,000 - 83,000; Full time

Job summary

Pyramid Consulting Healthcare is urgently seeking a Clinical Pharmacist 1 for a 03+ month contract in Austin, TX. This onsite role offers $58-$60/hour with benefits such as health insurance, 401(k), and paid sick leave depending on work location.

Responsibilities include reviewing prior authorization requests, ensuring eligibility, applying clinical criteria, and communicating with providers to resolve formulary and coverage issues.

Qualifications

• Pharmacist with appeals and prior authorization experience.
• Managed Care Experience required.
• 1+ years of professional pharmacist experience.
• Active pharmacist license in good standing in at least one U.S. state.

Responsibilities

• Review completed prior authorization requests and evaluate denials and alternatives.
• Verify member eligibility, prescription benefits and plan coverage.
• Review claims history, lab results and medical records.
• Apply policies to determine approval requirements.
• Exercise independent judgment for non-guideline requests.
• Research drug information and provide clinical recommendations.
• Communicate with providers on formulary coverage and alternatives.
• Review and evaluate pharmacy claims requiring audit or review.
• Compile data and prepare reports on utilization and denials.
• Recommend formulary updates and policy changes.
• Support quality initiatives and operational improvements.

Education

PharmD degree

Tools

Microsoft Office

MHK

Micromedex

AHFS

Job description

Immediate need for a talented Clinical - Pharmacist 1. This is a 03+ Months Contract opportunity with long-term potential and is located in Austin, TX(Onsite).

Job ID:26-32759

Pay Range: $58 - $60/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Review completed prior authorization requests submitted by healthcare providers and evaluate recommended denials, formulary alternatives, clinical notes, and supporting documentation.
• Verify member identification, eligibility, prescription benefits, and applicable health plan coverage.
• Review prescription claims history, laboratory results, medical records, and other relevant clinical information.
• Apply established medical policies and clinical criteria to determine whether medication requests meet approval requirements.
• Exercise independent professional judgment when evaluating requests that fall outside established Pharmacy and Therapeutics (P&T) Committee guidelines.
• Research drug information and provide clinical recommendations to physicians and pharmacy technicians.
• Communicate with healthcare providers regarding non-formulary medications, coverage limitations, quantity restrictions, age requirements, and alternative therapies.
• Review and evaluate pharmacy claims, including claims requiring additional audit or clinical review.
• Compile data and prepare reports related to medication utilization, overturned denials, formulary recommendations, and other pharmacy operations.
• Recommend updates to formulary guidelines, medication restrictions, quantity limits, and other pharmacy benefit policies.
• Support pharmacy quality initiatives and contribute to ongoing operational improvements.

Key Requirements and Technology Experience:

• Pharmacist with appeals and prior authorization experience.
• Managed Care Experience required.
• 1+ years of professional pharmacist experience.
• Doctor of Pharmacy (PharmD) degree.
• Active pharmacist license in good standing in at least one U.S. state.
• Strong clinical assessment and medication review skills.
• Excellent written and verbal communication skills.
• Strong organizational, time management, and analytical abilities.
• Proficiency with Microsoft Office applications.
• Ability to manage high-volume workloads while maintaining accuracy and productivity.
• Experience in pharmacy prior authorization, appeals, or utilization management.
• Knowledge of managed care pharmacy operations and prescription benefit plans.
• Familiarity with Medicare and Medicaid regulations.
• Experience with pharmacy or clinical review systems such as MHK, Client, Micromedex, or AHFS.
• Experience evaluating formulary exceptions, non-formulary medications, and medical necessity requests.
• Demonstrated ability to meet productivity goals in a high-volume review environment.

Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By applying to our jobs, you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.