Prior Authorization Pharmacist: Clinical Coverage Expert

IntePros; Philadelphia (Philadelphia County); On-site; USD 90,000 - 130,000; Full time

Job summary

IntePros in Philadelphia is seeking a licensed Pharmacist to join the Prior Authorization team and support clinical coverage determinations for pharmaceutical products. The role reviews prior authorization requests, applies pharmacy guidelines and regulatory requirements, and makes medical necessity and benefit coverage decisions with sound clinical judgment.

You will collaborate with senior pharmacists and the Customer Care Center, maintain documentation, and stay current with industry

Qualifications

• Bachelor’s degree in Pharmacy is required; PharmD preferred.
• Experience with prior authorization, pharmacy benefit management, utilization management, or coverage determinations is preferred.
• Strong clinical judgment and ability to interpret clinical documentation and medication-related information.
• Strong written and verbal communication skills.
• Ability to work independently while collaborating within a team.

Responsibilities

• Review and evaluate prior authorization and coverage determination requests for pharmaceutical products.
• Make clinical determinations regarding medical necessity and benefit coverage based on established criteria, guidelines, plan requirements, and regulations.
• Apply independent clinical judgment when reviewing member-specific information and medication requests.
• Communicate with prescribing providers to obtain additional information when needed.
• Provide clinical support to the Customer Care Center regarding medication coverage and PA requirements.
• Collaborate with senior pharmacists, supervisors, and internal teams on complex or escalated cases.
• Maintain knowledge of pharmacy industry trends, guidelines, new therapies, and regulatory changes.

Skills

Clinical judgment

Communication skills

Independent work

Attention to detail

Windows proficiency

Education

Bachelor’s degree in Pharmacy

PharmD preferred

Job description

IntePros in Philadelphia is seeking a licensed Pharmacist to join the Prior Authorization team and support clinical coverage determinations for pharmaceutical products. The role reviews prior authorization requests, applies pharmacy guidelines and regulatory requirements, and makes medical necessity and benefit coverage decisions with sound clinical judgment.

You will collaborate with senior pharmacists and the Customer Care Center, maintain documentation, and stay current with industry