Onsite Clinical Pharmacist - Prior Authorization & Appeals

Pyramid Consulting Healthcare; Austin (TX); On-site; USD 80,000 - 83,000; Full time

Job summary

Pyramid Consulting Healthcare is urgently seeking a Clinical Pharmacist 1 for a 03+ month contract in Austin, TX. This onsite role offers $58-$60/hour with benefits such as health insurance, 401(k), and paid sick leave depending on work location.

Responsibilities include reviewing prior authorization requests, ensuring eligibility, applying clinical criteria, and communicating with providers to resolve formulary and coverage issues.

Qualifications

• Pharmacist with appeals and prior authorization experience.
• Managed Care Experience required.
• 1+ years of professional pharmacist experience.
• Active pharmacist license in good standing in at least one U.S. state.

Responsibilities

• Review completed prior authorization requests and evaluate denials and alternatives.
• Verify member eligibility, prescription benefits and plan coverage.
• Review claims history, lab results and medical records.
• Apply policies to determine approval requirements.
• Exercise independent judgment for non-guideline requests.
• Research drug information and provide clinical recommendations.
• Communicate with providers on formulary coverage and alternatives.
• Review and evaluate pharmacy claims requiring audit or review.
• Compile data and prepare reports on utilization and denials.
• Recommend formulary updates and policy changes.
• Support quality initiatives and operational improvements.

Education

PharmD degree

Tools

Microsoft Office

MHK

Micromedex

AHFS

Job description

Pyramid Consulting Healthcare is urgently seeking a Clinical Pharmacist 1 for a 03+ month contract in Austin, TX. This onsite role offers $58-$60/hour with benefits such as health insurance, 401(k), and paid sick leave depending on work location.

Responsibilities include reviewing prior authorization requests, ensuring eligibility, applying clinical criteria, and communicating with providers to resolve formulary and coverage issues.