Pharmacist Operations Advisor

• 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.

Clinical Review (60%)

• Evaluate and review prior authorization requests

• Verify insurance coverage and eligibility

• Apply clinical guideline criteria to coverage determinations

• 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.

• Please explain any employment gaps on your resume.
• Ensure your application includes internet speed, license screenshot, and shift preference.