Remote Pharmacist I, Clinical Prior Authorization

Navitus; Atlanta (GA); Remote; USD 98,000 - 135,000; Full time

Benefits offered by this job

Health, Dental, Vision insurance

Paid time off (20 days)

Parental leave (4 weeks)

9 paid holidays

401K company match (up to 5%)

Adoption assistance

Flexible Spending Account

Educational assistance & professional

Referral bonus program

Job summary

Navitus Health Solutions is seeking a Pharmacist I, Clinical Prior Authorization to support drug utilization and clinical programs. You will review prior authorization requests, contribute to formulary decisions, and liaise with physicians, pharmacists, and specialty providers to optimize patient care.

In this role, you will handle coverage determinations, maintain program quality, and train staff on clinical issues while supporting operational PBM activities.

Qualifications

• Bachelor’s degree in Pharmacy or PharmD and active pharmacist licensure or reciprocity within 4 months.
• Knowledge of PBM industry, formulary management, and managed care principles.
• Strong clinical judgment and ability to translate clinical data for systems.
• Proficiency with drug literature and clinical trial evaluation.

Responsibilities

• Support clinical programs like Health Management, Drug Utilization Review, Formulary development and Prior Authorization.
• Review coverage determinations and make denials or approvals per criteria; identify self by name and role at Navitus.
• Monitor quality and efficiency of coverage criteria and denial language with prescribers.
• Contribute to clinical content of new programs and maintain existing ones.
• Complete annual URAC training requirements.
• Communicate with clients, members, and internal staff about clinical issues and objectives.
• Assist operational departments implementing PBM programs and daily member care operations.
• Provide clinical expertise to formulary decisions by the Pharmacy and Therapeutics committee.
• Review Medicare Part D data and perform phone consultations as needed; document calls.

Skills

Clinical judgment

PBM knowledge

Drug literature evaluation

Communication

Problem-solving

Attention to detail

Education

Pharmacy degree (B.Pharm/ PharmD)

State Pharmacist license

Tools

MS Word

Excel

PowerPoint

Job description

Navitus Health Solutions is seeking a Pharmacist I, Clinical Prior Authorization to support drug utilization and clinical programs. You will review prior authorization requests, contribute to formulary decisions, and liaise with physicians, pharmacists, and specialty providers to optimize patient care.

In this role, you will handle coverage determinations, maintain program quality, and train staff on clinical issues while supporting operational PBM activities.