Clinical Pharmacist – Prior Authorization & Outcomes

EmpiRx Health, LLC.; Montvale (NJ); On-site; USD 110,000 - 140,000; Full time

Benefits offered by this job

Paid Time Off

401(k) program

Health Insurance including Dental &amp

Vision coverage

Health Savings Account

Employee Assistance Program

Job summary

EmpiRx Health, a leading clinically-driven PBM, seeks a Clinical Pharmacist – Prior Authorization to ensure clinically appropriate care and sustainable savings for clients in Montvale, NJ. The role emphasizes medical decision-making, peer-to-peer provider interactions, and continuous QA within a fast-paced team.

This position requires a Pharm.D. and at least 3 years of PBM/managed care experience, with strong communication skills and proficiency in pharmacy software.

Qualifications

• Pharm.D. degree from an accredited college of pharmacy (Preferred)
• Minimum of 3 years of pharmacy experience in clinical, PBM, or managed care settings
• Prior authorization, utilization management, or health plan operations experience preferred
• MTM or other specialty certifications preferred
• Strong clinical judgment and analytical skills
• Excellent written and verbal communication with providers and medical staff

Responsibilities

• Act as a clinical expert on prior authorization review and evaluation per criteria and plan design
• Conduct thorough evaluations and resolutions of clinical reviews with physicians
• Perform peer-to-peer reviews with providers when needed
• Convey determinations promptly to prescribers and members
• Monitor clinical interventions to meet savings guarantees
• Stay informed about formulary changes and internal policies
• Collaborate with internal teams for reviews and provider support
• Utilize pharmacy management software and MS Office for documentation and reporting
• Access external drug information databases to support decisions

Skills

Pharmacist experience

Prior authorization experience

Clinical reviews

Communication with providers

Analytical skills

Independence and teamwork

Education

Doctor of Pharmacy (Pharm.D.)

Tools

Pharmacy management software

Microsoft Office

Job description

EmpiRx Health, a leading clinically-driven PBM, seeks a Clinical Pharmacist – Prior Authorization to ensure clinically appropriate care and sustainable savings for clients in Montvale, NJ. The role emphasizes medical decision-making, peer-to-peer provider interactions, and continuous QA within a fast-paced team.

This position requires a Pharm.D. and at least 3 years of PBM/managed care experience, with strong communication skills and proficiency in pharmacy software.