Remote Prior Authorization Pharmacist - Optimize Care Costs

OccuNet; Amarillo, Northern (TX, KY); Hybrid; USD 120,000 - 150,000; Full time

Benefits offered by this job

Health insurance

Vision insurance

Health savings account

401(k) with matching

Paid time off

Job summary

OccuNet is hiring a Pharmacist for Prior Authorization in a mostly remote role. You will review requests, apply clinical criteria, and coordinate with providers to ensure appropriate, cost-effective therapies.

The position emphasizes leadership in clinical programs, utilization management, and ongoing quality improvements within a collaborative team. A PharmD or BSPharm degree and active licensure are required.

Qualifications

• PharmD or BSPharm degree from an accredited college of pharmacy.
• Active pharmacist license; multi-state licensure may be required.
• Minimum 1 year of direct prior authorization or utilization management experience.
• Experience applying evidence-based clinical guidelines in pharmacy practice.

Responsibilities

• Review PA requests using member benefits and clinical criteria.
• Provide recommendations for formulary alternatives and cost savings.
• Coordinate appeals and communicate decisions to providers and members.
• Develop and maintain PA criteria, guidelines, and QA improvements.
• Analyze utilization data to identify trends and opportunities.

Skills

Clinical knowledge

PBM knowledge

Evidence-based medicine

Excel proficiency

Communication skills

Team collaboration

Education

PharmD or BSPharm degree

Tools

Medi-Span database

Pharmacy management systems

Job description

OccuNet is hiring a Pharmacist for Prior Authorization in a mostly remote role. You will review requests, apply clinical criteria, and coordinate with providers to ensure appropriate, cost-effective therapies.

The position emphasizes leadership in clinical programs, utilization management, and ongoing quality improvements within a collaborative team. A PharmD or BSPharm degree and active licensure are required.