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Job Requirements of Pharmacist - Prior Authorizations:
-
Employment Type:
Contractor
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Location:
North Carolina, US (Onsite)
Do you meet the requirements for this job?
Pharmacist - Prior Authorizations
Careers Integrated Resources Inc
North Carolina, US (Onsite)
Contractor
Job Title: Pharmacist Prior Authorization
Job Duration:6+ Months (Possibilities of extension)
Shift: 11:00 AM 7:30 PM EST
Job Location: Remote
Position Summary:
- The Clinical Pharmacist on the Prior Authorization team reviews and evaluates prior authorization (PA) requests for specialty and non-specialty medications. The role involves applying clinical judgment, interpreting insurance and clinical guidelines, and ensuring timely, accurate decisions in alignment with plan design and protocols.
- Review prior authorization requests; make coverage determinations based on clinical criteria and plan policies.
- Verify insurance coverage and eligibility.
- Interpret and apply clinical guideline criteria accurately.
- Communicate decisions clearly and promptly to providers, patients, and health
Required Experience & Skills:
- Active Pharmacist license in North Carolina
- Call center and clinical pharmacy experience
- Strong knowledge and use of clinical resources (e.g., Micromedex, Lexicomp, Clinical Pharmacology)
- Excellent time management and prioritization skills
- Must hold an active NC Pharmacist License; may reside in any state
Education:
- Bachelor of Science in Pharmacy or Doctor of Pharmacy (Pharm.D.)
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