Remote Prior Authorization Pharmacist - Clinical Leader

The-Occunet-Company-1; Amarillo (TX); On-site; USD 110,000 - 140,000; Full time

Benefits offered by this job

Health insurance

401(k) with matching

Paid time off

Vision insurance

Health savings account

Job summary

The OccuNet Company is seeking a Pharmacist for the Prior Authorization program, working remotely. You will review and authorize pharmacy prior authorization requests to ensure appropriate medication use per benefits and clinical criteria, while guiding utilization management and cost-effective care.

The role emphasizes clinical leadership, collaboration with prescribers and internal stakeholders, and development of clinical criteria to improve quality and reduce costs in a fast-paced,

Qualifications

• Bachelor of Science in Pharmacy (BSPharm) or Doctor of Pharmacy (Pharm.D.) degree from an accredited college of pharmacy.
• Active, current, and unrestricted Pharmacist license.
• Minimum of one (1) year of direct prior authorization or utilization management experience.
• Experience applying evidence-based clinical guidelines in pharmacy practice.

Responsibilities

• Review and evaluate prior authorization requests in accordance with member benefit plans, clinical guidelines, client policies, and regulatory requirements.
• Complete prior authorization reviews within established turnaround time requirements while maintaining high standards of clinical quality and accuracy.
• Apply evidence-based clinical criteria to determine medical necessity and appropriateness of requested drug therapies.
• Identify opportunities for therapeutic optimization and cost-effective medication management while maintaining clinical efficacy and patient safety.
• Collaborate with prescribing providers to recommend clinically appropriate, cost-effective formulary alternatives when applicable.
• Provide clinical recommendations that promote appropriate medication utilization and adherence to formulary management strategies.

Skills

Clinical review

Utilization management

Communication

Excel

Medi-Span knowledge

Education

BSPharm or Pharm.D.

Tools

Medi-Span

Pharmacy management system

Excel

Job description

The OccuNet Company is seeking a Pharmacist for the Prior Authorization program, working remotely. You will review and authorize pharmacy prior authorization requests to ensure appropriate medication use per benefits and clinical criteria, while guiding utilization management and cost-effective care.

The role emphasizes clinical leadership, collaboration with prescribers and internal stakeholders, and development of clinical criteria to improve quality and reduce costs in a fast-paced,