Remote Pharmacist I, Clinical Prior Authorization

Navitus; Des Moines (IA); Remote; USD 110,000 - 150,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Parental leave

Holidays

401K match

Adoption assistance

Flexible Spending Account

Educational assistance

Referral bonus

Job summary

Navitus Health Solutions is hiring a Pharmacist I, Clinical Prior Authorization to perform prior authorizations, drug utilization reviews, and clinical calls requiring pharmacist intervention. You will interface with physicians, pharmacists, and PBM providers to review beneficiary benefits and interventions, and evaluate utilization data for program development.

The role emphasizes collaboration, clinical decision-making, and quality assurance across Navitus programs, with opportunities to

Qualifications

• Bachelor’s degree in Pharmacy or PharmD and active pharmacist license in residence state
• Two years’ clinical or managed care experience preferred
• Knowledge of PBM, formulary management, and pharmacy claims desired
• Strong clinical judgment and ability to translate info for clinical systems
• Proficiency with MS Word, Excel, and PowerPoint; attention to detail

Responsibilities

• Support and input to clinical programs (Health Management, Drug Utilization Review, Formulary development, Prior Authorization) to improve efficiency and accuracy
• Participate in Coverage Determination processes and determine coverage when criteria are not clearly met
• Monitor quality and efficiency of coverage determinations and communicate with prescribers
• Contribute to clinical content for new or existing programs
• Complete URAC training requirements annually
• Educate clients, members, and internal staff on daily clinical issues and objectives
• Support operational departments in implementing PBM programs and daily member care
• Provide clinical expertise for formulary decisions by the Pharmacy and Therapeutics committee
• Review health survey data and perform phone consultations when needed
• Perform other duties as assigned

Skills

Pharmacist licensure

Clinical proficiency

PBM knowledge

Data review

Communication

Education

Bachelor’s or PharmD

Tools

MS Word

Excel

PowerPoint

Job description

Navitus Health Solutions is hiring a Pharmacist I, Clinical Prior Authorization to perform prior authorizations, drug utilization reviews, and clinical calls requiring pharmacist intervention. You will interface with physicians, pharmacists, and PBM providers to review beneficiary benefits and interventions, and evaluate utilization data for program development.

The role emphasizes collaboration, clinical decision-making, and quality assurance across Navitus programs, with opportunities to