Remote Pharmacist: Clinical Prior Authorization

Navitus; Lansing (MI); A distancia; USD 85.000 - 110.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health insurance

Dental insurance

Vision insurance

Paid time off 20 days

Parental leave 4 weeks

401K with company match

Education assistance

Referral bonus $750

Descripción de la vacante

Navitus Health Solutions is seeking a Pharmacist I, Clinical Prior Authorization to manage Prior Authorizations, Drug Utilization Review, and formulary decisions. You will interface with physicians, pharmacists, and specialty providers to optimize beneficiary benefits and therapeutic interventions.

Qualified candidates hold a PharmD or Bachelor’s in Pharmacy with a current, unrestricted license and at least two years of clinical or managed care experience.

Formación

• Bachelor’s degree in Pharmacy or PharmD required.
• Active, unrestricted pharmacist license in home state.
• 2 years clinical or managed care experience preferred.
• Knowledge of PBM, formulary management, and claims helpful.
• Strong clinical judgment and literature evaluation skills.

Responsabilidades

• Support clinical programs: Health Mgmt, DUR, formulary & PA programs.
• Review requests in Coverage Determination when not clearly approvable.
• Monitor denial language and communication with prescribers.
• Contribute to clinical content for new/maintained programs.
• Complete URAC training requirements annually.
• Educate clients, members, and staff on clinical issues.
• Support PBM program implementation for operations.
• Provide clinical input on formulary decisions.
• May review health surveys and conduct pharmacist calls.
• Other duties as assigned.

Conocimientos

Clinical prioritization

PBM knowledge

Clinical judgment

Communication with physicians

Documentation & data interpretation

Educación

PharmD degree

Active pharmacist license

Herramientas

MS Word

Excel

PowerPoint

Descripción del empleo

Navitus Health Solutions is seeking a Pharmacist I, Clinical Prior Authorization to manage Prior Authorizations, Drug Utilization Review, and formulary decisions. You will interface with physicians, pharmacists, and specialty providers to optimize beneficiary benefits and therapeutic interventions.

Qualified candidates hold a PharmD or Bachelor’s in Pharmacy with a current, unrestricted license and at least two years of clinical or managed care experience.