Remote Pharmacist I, Clinical Prior Authorization

Navitus; Nashville (TN); Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Parental leave

Holidays

401K match

Job summary

Navitus Health Solutions is seeking a Pharmacist I, Clinical Prior Authorization to perform prior authorizations, drug utilization reviews, and support clinical calls requiring pharmacist intervention. You will interface with physicians, pharmacists, and specialty providers to review benefits and therapeutic interventions.

The role emphasizes clinical judgment, program development, and cross-functional collaboration in a PBM environment, with ongoing URAC training and opportunities to impact

Qualifications

• Licensure as a Registered Pharmacist in home state or eligible for reciprocity within 4 months.
• Minimum 2 years of clinical or managed care pharmacy practice experience preferred.
• Knowledge of PBM industry, formulary management, and managed care principles desired.
• Strong clinical judgment and ability to translate clinical data for diverse audiences.
• Proficiency with drug literature/databases (e.g., Micromedex, Medline).
• Attention to detail to ensure accuracy and operational readiness.
• MS Office skills (Word/Excel/PowerPoint) for documentation and reporting.
• Commitment to compliance and teamwork across departments.

Responsibilities

• Support clinical programs like Health Management, DUR, Formulary, and Prior Authorization to drive quality and cost effectiveness.
• Review coverage determinations and communicate where appropriate with prescribing providers.
• Monitor and improve the coverage determination process, including criteria and denial language.
• Contribute to clinical content for new and existing programs.
• Complete URAC training requirements annually.
• Educate clients, members, and staff on daily clinical issues and objectives.
• Support PBM program implementation and daily member care operations.
• Provide clinical input on formulary decisions by Pharmacy and Therapeutics committee.
• Conduct health surveys of Medicare Part D participants or phone consults when needed.
• Perform other duties as assigned.

Skills

Pharmacist licensure

Clinical prioritization

PBM knowledge

Communication with clinicians

Education

Bachelor’s in Pharmacy

PharmD

Tools

MS Word

Excel

PowerPoint

Job description

Navitus Health Solutions is seeking a Pharmacist I, Clinical Prior Authorization to perform prior authorizations, drug utilization reviews, and support clinical calls requiring pharmacist intervention. You will interface with physicians, pharmacists, and specialty providers to review benefits and therapeutic interventions.

The role emphasizes clinical judgment, program development, and cross-functional collaboration in a PBM environment, with ongoing URAC training and opportunities to impact