Licensed Pharmacist – Prior Authorization Expert

Ohm Systems; Philadelphia (Philadelphia County); On-site; USD 110,000 - 140,000; Full time

Job summary

PerformRx is seeking a licensed Pharmacist (R) to join the Prior Authorization Department in Philadelphia. The role focuses on making determinations on prior authorization requests, including medical necessity and benefit decisions, in accordance with guidelines and regulations.

The position involves independent reviews with supervisory support, and a rotating weekend schedule based on business needs. A pharmacy license in good standing is required, with a preference for PA/Coverage

Qualifications

• Active pharmacist license in good standing in any U.S. state.
• PharmD degree or equivalent; licensure required.
• Experience with Prior Authorization or Coverage Determination is preferred.

Responsibilities

• Make determinations on prior authorization requests for coverage of pharmaceutical products.
• Work independently with support from Pharmacist II and supervisors.
• Rotate weekend schedule if business needs dictate.
• Provide clinical support to the Customer Care Center.
• Engage providers to support determinations.
• Stay updated on industry trends and regulatory changes.

Skills

No experience required

PA/Coverage review

Windows PC skills

Education

Bachelor's Degree

PharmD preferred

Current Pharmacist license

Job description

PerformRx is seeking a licensed Pharmacist (R) to join the Prior Authorization Department in Philadelphia. The role focuses on making determinations on prior authorization requests, including medical necessity and benefit decisions, in accordance with guidelines and regulations.

The position involves independent reviews with supervisory support, and a rotating weekend schedule based on business needs. A pharmacy license in good standing is required, with a preference for PA/Coverage