Remote Pharmacist I, Clinical Prior Authorization

Navitus; Baton Rouge (LA); Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

Health, Dental, Vision insurance

20 days paid time off

4 weeks parental leave

9 paid holidays

401K match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Profes

Referral Bonus Program - up to $750!

Job summary

Navitus Health Solutions is seeking a Pharmacist I, Clinical Prior Authorization to join our team. The role performs prior authorizations, reviews drug utilization and supports customer care with pharmacist interventions.

You will interface with physicians, pharmacists, and specialty providers regarding benefits and therapeutic interventions. You will review health surveys and utilization data, participate in pharmacoeconomic discussions, and contribute to formulary decisions.

Qualifications

• Bachelor’s degree in Pharmacy or PharmD with active pharmacist license.
• Two years’ clinical or managed care experience preferred.
• Knowledge of PBM industry and formulary management.
• Ability to translate clinical information for diverse audiences.

Responsibilities

• Support clinical programs such as Health Management, Drug Utilization Review, Formulary development, and Prior Authorization programs.
• Review and determine coverage determinations and medical exceptions.
• Monitor quality and efficiency of the Coverage Determination process.
• Provide input to clinical content of new programs and URAC training requirements.
• Educate clients, members, and internal staff on clinical issues and objectives.
• Assist operational departments with PBM program implementation.

Skills

Clinical decision making

Communication skills

Problem solving

MS Word basics

Excel basics

Pharmacy knowledge

Education

Bachelor’s degree in Pharmacy

Doctor of Pharmacy (PharmD)

Tools

Micromedex

Medline

EHR systems

Formulary management systems

Job description

Navitus Health Solutions is seeking a Pharmacist I, Clinical Prior Authorization to join our team. The role performs prior authorizations, reviews drug utilization and supports customer care with pharmacist interventions.

You will interface with physicians, pharmacists, and specialty providers regarding benefits and therapeutic interventions. You will review health surveys and utilization data, participate in pharmacoeconomic discussions, and contribute to formulary decisions.