Remote Pharmacist I: Clinical Prior Authorization

Navitus; Indianapolis (IN); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Health, dental, and vision insurance

20 days paid time off

4 weeks parental leave

9 paid holidays

401K match up to 5%

Adoption Assistance

Flexible Spending Account

Education Assistance & Professional D"

Job summary

Navitus Health Solutions is hiring a Pharmacist I, Clinical Prior Authorization to perform prior authorizations and drug utilization reviews. The role interfaces with physicians, pharmacists, and specialty providers to optimize benefits and therapeutic interventions.

The candidate will review health surveys and utilization data for program management and development, and provide clinical input to current and new programs. Certification and licensure are required.

Qualifications

• Pharmacist licensure in the resident state and ability to reciprocity where required.
• Two years of clinical or managed care experience preferred.
• Knowledge of PBM industry and formulary management desirable.

Responsibilities

• Support clinical programs such as Health Management, Drug Utilization Review, Formulary development, and Prior Authorization programs.
• Review requests for coverage determinations and issue denial determinations when criteria are not met.
• Monitor quality and efficiency of the coverage determination process and communicate with prescribers.
• Contribute to clinical content for new and existing programs; complete URAC training.
• Educate clients, members, and staff on daily clinical issues and objectives.
• Assist operational departments with PBM program implementation and daily workflows.

Education

Bachelor’s degree in Pharmacy or Pharm D

Tools

MS Word

Excel

PowerPoint

Job description

Navitus Health Solutions is hiring a Pharmacist I, Clinical Prior Authorization to perform prior authorizations and drug utilization reviews. The role interfaces with physicians, pharmacists, and specialty providers to optimize benefits and therapeutic interventions.

The candidate will review health surveys and utilization data for program management and development, and provide clinical input to current and new programs. Certification and licensure are required.