Clinical Pharmacist | Prior Authorization Expert

Creative Solutions Services, LLC; Woonsocket (RI); On-site; USD 110,000 - 140,000; Full time

Job summary

US Tech Solutions seeks a Pharmacist – Prior Authorization Advisor to evaluate PA requests, apply clinical criteria, and render coverage determinations. The role involves inbound/outbound calls with physicians, members, and providers, plus collaboration with the PA team to collect essential data.

The candidate must hold an active pharmacist license in their state, have PBM and managed care experience, and be able to work within defined SLAs.

Qualifications

• Must have Managed Care experience and Medicare/Medicaid knowledge.
• Must have at least 6 months of Prior Authorization experience.
• Pharmacy Benefit Management (PBM) experience is required.
• Active pharmacist license in state of residence in good standing.

Responsibilities

• Evaluate and review prior authorization requests and render coverage determinations based on clinical criteria.
• Collaborate with technicians and PA team to process referrals and gather clinical data.
• Maintain knowledge of drugs and disease states for Specialty and Non-Specialty Pharmacy programs.
• Provide on-call after-hours pharmacist availability as needed.

Skills

Managed care

Medicare/Medicaid knowledge

Prior Authorization experience

Education

Pharm D. with managed care experience

Job description

US Tech Solutions seeks a Pharmacist – Prior Authorization Advisor to evaluate PA requests, apply clinical criteria, and render coverage determinations. The role involves inbound/outbound calls with physicians, members, and providers, plus collaboration with the PA team to collect essential data.

The candidate must hold an active pharmacist license in their state, have PBM and managed care experience, and be able to work within defined SLAs.