Clinical Pharmacist - Prior Authorization Specialist

LucyRx; United States; Hybrid; USD 85,000 - 99,000; Full time

Job summary

LucyRx in the United States is seeking a Clinical Pharmacist to conduct clinical reviews of prior authorization requests, ensuring evidence-based decisions and regulatory compliance.

You will evaluate documentation, communicate outcomes with providers, and participate in quality assurance and process improvements. This largely office-based role may involve occasional travel and requires a Pharmacy Doctor or BS and active license.

Qualifications

• Doctor of Pharmacy or 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.

Responsibilities

• Review and process 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.

Skills

Organizational skills

Written communication

Verbal communication

Interpersonal skills

Detail-oriented

Critical thinking

HIPAA knowledge

Education

Doctor of Pharmacy or BS Pharmacy with equivalent experience

Tools

Microsoft Office

Job description

LucyRx in the United States is seeking a Clinical Pharmacist to conduct clinical reviews of prior authorization requests, ensuring evidence-based decisions and regulatory compliance.

You will evaluate documentation, communicate outcomes with providers, and participate in quality assurance and process improvements. This largely office-based role may involve occasional travel and requires a Pharmacy Doctor or BS and active license.