Clinical Pharmacist - Prior Authorization Specialist

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

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.