Remote Pharmacist – Clinical Prior Authorization Specialist

Navitus; Richmond (VA); Remote; USD 110,000 - 140,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

20 days paid time off

4 weeks paid parental leave

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan

Job summary

Navitus is hiring a Pharmacist I, Clinical Prior Authorization to perform prior authorizations, conduct drug utilization review and support the Customer Care team with pharmacist interventions. You will interact with physicians and pharmacy providers to review beneficiary benefits and optimize therapy.

You will participate in clinical program development, assist in formulary decisions, and help ensure accuracy and efficiency in coverage determinations.

Qualifications

• Bachelor's degree in Pharmacy or PharmD required with current, unrestricted licensure.
• Clinical experience in a pharmacy setting preferred, including drug utilization and prior authorization processes.
• Familiarity with PBM programs, formulary management, and managed care principles desired.

Responsibilities

• Support clinical programs including Health Management, Drug Utilization Review, Formulary development, and Prior Authorization to ensure high quality, cost effective therapy.
• Review requests in the Coverage Determination process and communicate professional judgments clearly and efficiently.
• Monitor coverage criteria and denial language; educate clients and staff on clinical issues and program objectives.

Skills

Clinical expertise

Pharmacist licensure

PBM knowledge

Communication skills

Data interpretation

Education

Bachelor's degree in Pharmacy or PharmD

Current, unrestricted pharmacist licensure

Tools

MS Word

Excel

PowerPoint

Job description

Navitus is hiring a Pharmacist I, Clinical Prior Authorization to perform prior authorizations, conduct drug utilization review and support the Customer Care team with pharmacist interventions. You will interact with physicians and pharmacy providers to review beneficiary benefits and optimize therapy.

You will participate in clinical program development, assist in formulary decisions, and help ensure accuracy and efficiency in coverage determinations.