Remote Clinical Pharmacy Reviewer – Prior Authorization Pro

Dane Street; United States; Remote; USD 90.000 - 125.000; Vollzeit

Benefits dieser Stelle

Collaborative remote culture

Professional growth opportunities

Meaningful work supporting the health‑

Comprehensive benefits

Great Place to Work Certified since 0

Commitment to employee development

Zusammenfassung

Dane Street is seeking a Clinical Pharmacy Reviewer (Pharmacist) to evaluate complex prior authorization requests, appeals, and coverage determinations, ensuring clinical appropriateness and evidence-based compliance. This role serves as a pharmacotherapy expert within our PBM-focused team, interpreting formulary guidelines and DUR standards to uphold medical necessity.

The ideal candidate holds a PharmD with an active license in any US state and at least 3 years of PBM experience, including

Qualifikationen

• Doctor of Pharmacy (PharmD) degree from an accredited university.
• Active, unencumbered pharmacist license in any U.S. State.
• Minimum of 3 years of Prior Authorization and/or Appeals review experience within a PBM environment.
• Experience with Medicare Part D and Medicaid pharmacy benefits is preferred.
• Knowledge of step therapy requirements, quantity limit programs, and specialty medications is preferred.
• In-depth knowledge of Drug Utilization Review (DUR) and ability to apply complex clinical guidelines.

Aufgaben

• Evaluate complex prior authorization requests, appeals, and medication coverage determinations to ensure clinical appropriateness.
• Interpret drug criteria, formulary guidelines, step therapy, and quantity limits for specialty and non-specialty medications.
• Uphold medical necessity standards and regulatory compliance in PBM workflows.
• Collaborate with providers and payers to ensure appropriate access to medications of high clinical value.

Kenntnisse

Prior Authorization

Appeals review

Drug Utilization Review

Formulary management

Medicare Part D

Regulatory compliance

Ausbildung

PharmD degree

Active pharmacist license

Jobbeschreibung

Dane Street is seeking a Clinical Pharmacy Reviewer (Pharmacist) to evaluate complex prior authorization requests, appeals, and coverage determinations, ensuring clinical appropriateness and evidence-based compliance. This role serves as a pharmacotherapy expert within our PBM-focused team, interpreting formulary guidelines and DUR standards to uphold medical necessity.

The ideal candidate holds a PharmD with an active license in any US state and at least 3 years of PBM experience, including