Remote Pharmacist I - Clinical Prior Authorization

Navitus; Saint Paul (MN); On-site; USD 110,000 - 140,000; Full time

Benefits offered by this job

Health, dental, vision insurance

PTO 20 days

Parental leave 4 weeks

9 holidays

401K match up to 5%

Adoption assistance

Flexible Spending Account

Education assistance

Referral bonus $750

Job summary

Navitus Health Solutions is expanding its clinical team with a Pharmacist I, Clinical Prior Authorization. You will manage prior authorizations, conduct drug utilization reviews, and support care teams through pharmacist interventions while coordinating with physicians and specialty pharmacies.

You will review health surveys and utilization data to inform program management, work toward formulary decisions, and help maintain high-quality, cost-effective therapy for members.

Qualifications

• Bachelor's degree in Pharmacy or Pharm D and current, unrestricted licensure as a Registered Pharmacist.
• Two years’ clinical or managed care experience preferred.
• Knowledge of PBM, formulary management, and managed care principles.
• Strong clinical judgment for diverse patient scenarios.
• Familiarity with drug literature and clinical trial evaluation.
• Ability to communicate clinical information to varied audiences.
• Attention to detail to ensure accuracy and operability.
• Proficiency in MS Word, Excel, and PowerPoint.
• Commitment to compliance and collaborative teamwork.

Responsibilities

• Support clinical programs such as Health Management and Prior Authorization to promote cost-effective therapy.
• Review requests in coverage determinations and communicate outcomes with professional colleagues.
• Monitor coverage criteria and denial language; interact with prescribers.
• Contribute to clinical content for new and existing programs.
• Complete URAC annual training requirements.
• Assist clients, members, and staff with clinical questions and education.
• Support PBM program implementation and daily operations for members.
• Support formulary decisions by Pharmacy and Therapeutics committees.
• Review Medicare Part D surveys and perform phone consultations as needed.
• Undertake other duties as assigned.

Skills

Clinical pharmacy

PBM knowledge

Drug literature

Clinical judgment

MS Office

Communication

Problem solving

Education

Bachelor's degree in Pharmacy

PharmD degree

Tools

Micromedex

Medline

Microsoft Office

Job description

Navitus Health Solutions is expanding its clinical team with a Pharmacist I, Clinical Prior Authorization. You will manage prior authorizations, conduct drug utilization reviews, and support care teams through pharmacist interventions while coordinating with physicians and specialty pharmacies.

You will review health surveys and utilization data to inform program management, work toward formulary decisions, and help maintain high-quality, cost-effective therapy for members.