Prior Authorization Pharmacist — Long-Term Care & Hospice

RXPERTS Pharmacy Chicago; Morton Grove (IL); On-site; USD 83,000 - 85,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

401(k) with company match

Paid time off

Paid holidays

Group Life Insurance

Short-Term Disability

Professional development

Career advancement opportunities

Job summary

SpecialtyRx is seeking a knowledgeable Prior Authorization Pharmacist in Illinois to join our long-term care pharmacy team. You will review coverage requirements, manage prior authorizations, and address insurance denials to ensure timely access to prescribed medications for residents of long-term care facilities and hospice patients.

You will work with insurers, prescribers, facilities, and internal teams to resolve coverage restrictions and reimbursement challenges, leveraging strong clinical

Qualifications

• Doctor of Pharmacy (Pharm.D.) or Bachelor of Science in Pharmacy from an accredited institution.
• Experience with prior authorizations and insurance billing preferred.
• Long-term care pharmacy and hospice medication management experience preferred.
• Familiarity with Medicare Part D, Medicaid, and payer requirements preferred.
• Strong clinical assessment and communication skills.

Responsibilities

• Review medication orders and assess insurance coverage requirements and prior authorization criteria.
• Evaluate prior authorization requests for clinical appropriateness and medical necessity.
• Prepare, submit, and follow up on PA requests to state and private payers including Medicare Part D.
• Review insurance claim rejections and coordinate resolution with providers and payers.
• Communicate with prescribers and facilities to obtain supporting information for authorization.
• Work with payers and PBMs on coverage, overrides, and authorization status.
• Research formulary alternatives when denials occur and coordinate with prescribers.
• Assist with urgent access issues by prioritizing time-sensitive PA requests.

Skills

Prior authorizations

Insurance billing

Medicare Part D

Pharmacy regulations

Education

Pharm.D.

B.S. in Pharmacy

Tools

Pharmacy management systems

Electronic documentation

Microsoft Office

Job description

SpecialtyRx is seeking a knowledgeable Prior Authorization Pharmacist in Illinois to join our long-term care pharmacy team. You will review coverage requirements, manage prior authorizations, and address insurance denials to ensure timely access to prescribed medications for residents of long-term care facilities and hospice patients.

You will work with insurers, prescribers, facilities, and internal teams to resolve coverage restrictions and reimbursement challenges, leveraging strong clinical