Senior Prior Authorization Pharmacist (PBM/Appeals)

Medix™; United States; On-site; USD 68,000 - 97,000; Full time

Job summary

Medix in the United States seeks a Pharmacist to review and render decisions on authorizations and appeals for specialty, non-specialty, and physician-administered drugs. You will conduct peer-to-peer discussions with prescribers to support clinical rationale and participate in audits to ensure consistency.

Requirements include a Doctor of Pharmacy degree and at least 2 years’ PBM or health insurer prior authorization/appeals experience. Shifts run 7am–5:30pm CST (8/10 hours).

Qualifications

• Doctor of Pharmacy degree required.
• Minimum 2 years in PBM or health insurer handling prior authorizations or appeals.

Responsibilities

• Completing review and rendering decisions on authorizations and appeals for specialty, non-specialty, and physician administered drugs
• Conducting peer-to-peers with prescribers to discuss the clinical rationale of adverse determinations
• Participating in clinical quality audits (inter-rater reliability testing)
• Providing internal team support for escalations and questions from pharmacy technicians and physicians
• Developing and reviewing clinical criteria

Skills

Prior authorization experience

Education

Doctor of Pharmacy degree

Job description

Medix in the United States seeks a Pharmacist to review and render decisions on authorizations and appeals for specialty, non-specialty, and physician-administered drugs. You will conduct peer-to-peer discussions with prescribers to support clinical rationale and participate in audits to ensure consistency.

Requirements include a Doctor of Pharmacy degree and at least 2 years’ PBM or health insurer prior authorization/appeals experience. Shifts run 7am–5:30pm CST (8/10 hours).