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Job Requirements of Pharmacist Operations Advisor:
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Employment Type:
Contractor
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Location:
Rhode Island, US (Onsite)
Do you meet the requirements for this job?
Pharmacist Operations Advisor
Careers Integrated Resources Inc
Rhode Island, US (Onsite)
Contractor
Job Title: Pharmacist Operations Advisor
Job Location: Remote, RI
Job Duration: 5-6 Months (possibility of extension)
Payrate: $53.00/ hr on w2
Shifts Available
Production Shifts (Sun–Thu or Tue–Sat):
10:30 AM – 7:00 PM CST
11:00 AM – 7:30 PM CST
11:30 AM – 8:00 PM CST
Job Summary:
- The Pharmacist/Clinician will conduct clinical reviews of prior authorization requests in accordance with policy, procedure, and clinical guidelines.
- This role requires applying clinical knowledge to coverage determinations, supporting the Prior Authorization team, and handling physician/member inquiries.
- Some on-call availability may be required for urgent requests.
Responsibilities
Clinical Review (60%)
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Evaluate and review prior authorization requests
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Verify insurance coverage and eligibility
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Apply clinical guideline criteria to coverage determinations
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Communicate decisions promptly to providers, patients, and health plans
Knowledge Maintenance (10%)
- Stay current on drug and disease state knowledge for Specialty and Non-Specialty programs
Other Duties (5%)
- Participate in training/development meetings
- Provide after-hours/on-call support as needed
Required:
- Bachelor’s degree (BS Pharmacy)
- Active pharmacist license in state of residence/practice
- Experience in prior authorization, case review, or clinical review (commercial or specialty pharmacy preferred)
- Strong multitasking skills with multiple technology platforms
- Proficiency with Microsoft Office (Word, Excel)
- Excellent written and verbal communication skills
Preferred:
- Doctor of Pharmacy (PharmD)
- Prior experience in a high-volume production setting meeting service-level agreements
Note: Pharmacists with retail experience only are welcome to apply.
Application Guidance
- Please explain any employment gaps on your resume.
- Ensure your application includes internet speed, license screenshot, and shift preference.
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