Pharmacist - Prior Authorizations

Job Title: Pharmacist - Prior Authorizations
Job Location: Remote, NC
Job Duration: 6 Months+ (Possible Extension)

Shift: 11 am to 7.30 pm EST
License: Active, unrestricted Pharmacist license in North Carolina (in good standing)
 
Duties:

• Evaluate and review prior authorization requests, rendering coverage determinations based on clinical criteria and health plan design.
• Verify insurance coverage and eligibility while interpreting clinical guideline criteria.
• Consult with physicians and healthcare providers to support accurate clinical decision-making.
• Apply clinical knowledge and resources in compliance with departmental protocols and guidelines.
• Communicate approval and denial decisions clearly and promptly to providers, patients, health plans, and other stakeholders.
• Collaborate with pharmacy technicians and prior authorization team members to process referrals efficiently.
• Collect and review clinical and medical data required for accurate assessments within established service level agreements (SLAs).
• Handle inbound and outbound calls with providers, patients, and internal teams to facilitate authorizations, resolve inquiries, and manage escalations.
• Maintain up-to-date knowledge of drug therapies and disease states across specialty and non-specialty pharmacy programs.
• Support Medicaid and Commercial Prior Authorization and Case Review Unit (CRU) operations.
• Participate in training sessions, development meetings, and departmental initiatives.
• Provide on-call and after-hours pharmacist support as required.
• Perform additional duties and special projects as assigned.

 
Required Qualifications & Experience:

• Experience utilizing clinical reference tools such as Micromedex, Lexicomp, and Clinical Pharmacology.
• Background in clinical pharmacy and/or call center environments.
• Strong ability to prioritize tasks, manage multiple responsibilities, and adapt to changing situations.
• Excellent organizational skills with strong attention to detail.
• Proficiency in Microsoft Office and Windows-based applications.
• Strong verbal and written communication and interpersonal skills.
• Ability to work independently and make sound clinical decisions.
• Comfortable handling inbound calls from pharmacy technicians and healthcare providers for clinical support.