Remote Pharmacist I: Clinical Prior Authorization

Navitus; Phoenix (AZ); Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

Health, Dental, Vision insurance

20 days PTO

4 weeks parental leave

9 paid holidays

401K company match of up to 5%

Adoption Assistance

Flexible Spending Account

Educational Assistance Plan and Pro/M

Referral Bonus Program - up to $750

Job summary

Navitus Health Solutions in Phoenix, AZ seeks a Pharmacist I, Clinical Prior Authorization to perform prior authorizations, drug utilization review, and support Customer Care with pharmacist interventions. You will interface with physicians, pharmacists, and specialty providers regarding benefits and therapies, and review health surveys and utilization data for program management and development.

The role emphasizes input to clinical content, URAC training, and cross-team collaboration to

Qualifications

• Bachelor’s degree in Pharmacy or PharmD and active licensure in home state.
• Clinical or managed care pharmacy experience preferred.
• Knowledge of PBM, formulary management and managed care principles.

Responsibilities

• Support clinical programs such as Health Management, DUR, Formulary, and Prior Authorization.
• Review Coverage Determination requests and determine approvals/denials per criteria.
• Monitor quality and efficiency of Coverage Determination and communicate with prescribers.
• Contribute clinical content for new/maintained programs.
• Complete annual URAC training requirements.
• Educate clients, members, and staff on daily clinical issues and objectives.
• Support PBM program implementation and daily member care operations.
• Provide clinical input to formulary decisions by Pharmacy and Therapeutics committee.

Skills

Clinical judgment

Communication with healthcareproviders

Attention to detail

Problem solving

Team collaboration

Education

Bachelor's degree in Pharmacy or PharmD

Tools

Micromedex

Medline

Electronic databases

MS Word

Excel

PowerPoint

Job description

Navitus Health Solutions in Phoenix, AZ seeks a Pharmacist I, Clinical Prior Authorization to perform prior authorizations, drug utilization review, and support Customer Care with pharmacist interventions. You will interface with physicians, pharmacists, and specialty providers regarding benefits and therapies, and review health surveys and utilization data for program management and development.

The role emphasizes input to clinical content, URAC training, and cross-team collaboration to