Clinical Pharmacist - Prior Authorization & Utilization

Blue Cross & Blue Shield of Mississippi; Flowood (MS); On-site; USD 105,000 - 125,000; Full time

Job summary

Blue Cross & Blue Shield of Mississippi is seeking Clinical Pharmacists to review Prescription Drug Prior Authorization Requests and Appeals for coverage and medical necessity. The role focuses on patient care and medication optimization rather than routine dispensing, collaborating with the Chief Medical Director to guide benefit design decisions.

Two positions are available. Requirements include PharmD, Mississippi license, and 1+ year in a fast-paced setting, with strong clinical knowledge

Qualifications

• PharmD required; residency preferred.
• Current Mississippi Pharmacist license or intent to obtain.
• 1+ year experience in a fast-paced retail/pharmacy setting.
• Clinical pharmacy knowledge and data interpretation skills.
• Proficiency in Microsoft Office (Word/Excel).
• Strong written and verbal communication across teams.

Responsibilities

• Conduct clinical reviews of Prior Authorization Requests and Appeals.
• Research information to complete comprehensive reviews.
• Make objective determinations based on data and guidelines.
• Consult with Physician Reviewer for final determinations.
• Communicate decisions to providers, pharmacy teams and members.
• Meet quality and production timelines.

Skills

Clinical reviews

Communication with providers

Data interpretation

Multitasking

Healthcare economics understanding

Education

PharmD degree

Mississippi Pharmacist license

Tools

MS Word

MS Excel

Job description

Blue Cross & Blue Shield of Mississippi is seeking Clinical Pharmacists to review Prescription Drug Prior Authorization Requests and Appeals for coverage and medical necessity. The role focuses on patient care and medication optimization rather than routine dispensing, collaborating with the Chief Medical Director to guide benefit design decisions.

Two positions are available. Requirements include PharmD, Mississippi license, and 1+ year in a fast-paced setting, with strong clinical knowledge