Prior Authorization Pharmacist

Oscar; United States; Remote; USD 112,000 - 147,000; Full time

Benefits offered by this job

Unlimited vacation

Annual performance bonus

Job summary

Oscar Health is seeking a Prior Authorization Pharmacist to join our Pharmacy Team. This remote role supports authorizations for specialty, non-specialty, and physician-administered drugs from home.

You will review decisions, conduct peer-to-peer discussions with prescribers, and participate in clinical quality audits, reporting to the Clinical Pharmacist Supervisor. US licensure and 3+ years of pharmacist experience are required.

Qualifications

• Licensed pharmacist with active license in the United States.
• 2+ years of prior authorization review experience in managed care or similar setting.
• Strong understanding of clinical criteria and pharmacotherapy.

Responsibilities

• Review and render decisions on prior authorizations for various drug categories.
• Conduct peer-to-peer discussions with prescribers to explain determinations.
• Participate in clinical quality audits and inter-rater reliability checks.

Skills

Licensed Pharmacist

Prior Authorization

Clinical review

Team collaboration

Education

Doctor of Pharmacy (Pharm.D.)

Tools

Clinical guidelines

Job description

Start at Oscar pharmacy. Score 25% off your first online Rx order.

Hi, we're Oscar. We're hiring a Prior Authorization Pharmacist to join our Pharmacy Team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

This role serves as a reviewer of prior authorizations.

You will report into the Clinical Pharmacist Supervisor.

Work Location: This is a remote position, open to candidates who reside in: Alabama; Arizona; Arkansas; Colorado; Connecticut; District of Columbia; Florida; Georgia; Idaho; Illinois; Indiana; Iowa; Kansas; Kentucky; Maine; Maryland; Massachusetts; Michigan; Minnesota; Missouri; Nevada; New Hampshire; New Jersey; New Mexico; North Carolina; Ohio; Oregon; Pennsylvania; Rhode Island; South Carolina; Tennessee; Texas; Utah; Vermont; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote

Pay Transparency: The base pay for this role is: $ $111,780 -146,711.25 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

• Review and render decisions on authorizations and appeals for specialty, non-specialty, and physician administered drugs

• Conduct peer-to-peer calls with prescribers to discuss the clinical rationale of adverse determinations

• Participate in clinical quality audits and inter-rater reliability testing

• Provide internal team support for escalations and questions

• Apply clinical expertise to ensure appropriate and safe use of pharmaceuticals by members and providers.

• Compliance with all applicable laws and regulations

• Other duties as assigned

Requirements:

• 3+ years of experience as a licensed pharmacist

• 2+ years of experience performing prior authorization review in a managed care setting

• Doctor of Pharmacy Degree

• Willingness to obtain licensure/training with new states

• Clinical experience applying clinical criteria in clinical review setting

• Experience practicing pharmacy in a clinical setting (i.e. retail, hospital, and specialty)

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team ([e-mail]) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.

We like the way you work it · no gig iddy · Gotta bag it up · no gig iddy ·

We like the way you work it · no gig iddy · Gotta bag it up · no gig iddy ·