Prior Authorization Pharmacist for LTC & Hospice

Specialty Rx, INC.; Morton Grove (IL); On-site; USD 110,000 - 140,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Group Life Insurance

Short-Term Disability

Paid time off

Paid holidays

401(k) with company match

Professional development

Career advancement opportunities

Job summary

SpecialtyRx, Inc. is a Long-Term Care pharmacy seeking a knowledgeable Prior Authorization Pharmacist to join our Illinois team.

You will review coverage requirements, support PA submissions, resolve claim rejections, and ensure timely access to prescribed medications for long-term care facilities, hospice providers, and associated patients. The ideal candidate has strong clinical judgment and experience with payer requirements, insurance billing, and prior authorizations, with LTC and Medicare

Qualifications

• Doctor of Pharmacy (Pharm.D.) or Bachelor of Science in Pharmacy from an accredited institution.
• Active Illinois pharmacist license in good standing, required.
• Previous experience in pharmacy prior authorizations, insurance billing, utilization management, or medication coverage review preferred.
• Long-term care pharmacy experience preferred.

Responsibilities

• Review medication orders and assess insurance coverage requirements, formulary restrictions, and prior authorization criteria.
• Evaluate prior authorization requests for clinical appropriateness, medical necessity, and compliance with applicable payer requirements.
• Prepare, submit, and follow up on prior authorization requests to state-sponsored insurance plans, private insurers, Medicare Part D plans, and other applicable payers.
• Review insurance claim rejections and determine appropriate clinical or administrative steps to facilitate resolution.
• Communicate with prescribers and healthcare providers to obtain supporting clinical information, documentation, and clarification needed for authorization requests.

Skills

Clinical assessment

Insurance billing

Prior authorization

Communication with providers

Multidisciplinary teamwork

Education

Pharm.D. or B.S. in Pharmacy

Tools

Pharmacy management systems

Microsoft Office

Job description

SpecialtyRx, Inc. is a Long-Term Care pharmacy seeking a knowledgeable Prior Authorization Pharmacist to join our Illinois team.

You will review coverage requirements, support PA submissions, resolve claim rejections, and ensure timely access to prescribed medications for long-term care facilities, hospice providers, and associated patients. The ideal candidate has strong clinical judgment and experience with payer requirements, insurance billing, and prior authorizations, with LTC and Medicare