Clinical Pharmacist - Prior Authorization
Core
Clinical Pharmacist evaluating prior authorization requests and rendering coverage determinations for health plans and employers.
Role type
Senior IC clinical pharmacist (prior authorization)
Builds
Coverage decisions and clinical assessments for commercial pharmacy programs
Domain
Health insurance / Commercial pharmacy operations
Deliverable
production ML models | product features | dashboards & analysis | client delivery
Required skills
Clinical assessment, insurance coverage verification, clinical guideline interpretation, physician consultation, case review, data collection, approval/denial management, multitasking, system navigation, problem solving, attention to detail, mentorship of non-clinical staff
Preferred skills
Microsoft Office Suite (Access, Outlook, PowerPoint, Visio), keyboard proficiency
Technologies
Microsoft Office Suite, internal prior authorization systems
Responsibilities
Process referrals and collect clinical data for assessments, evaluate prior authorization requests and render coverage determinations, communicate decisions to providers and patients, handle inbound/outbound calls for inquiries and escalations, maintain knowledge of drug and disease states, provide on-call availability
Seniority
Senior, hands-on IC