About the role
Responsibilities:
• Review and render decisions on prior authorizations requests for drugs under the pharmacy benefit
• Conduct peer-to-peer calls with prescribers to discuss the clinical rationale of adverse determinations
• Participate in clinical quality audits and inter-rater reliability testing
• Provide support to internal teams for escalations and questions from the pharmacy team
• Apply clinical expertise to ensure appropriate and safe use of pharmaceuticals by members and providers
• Compliance with all applicable laws and regulations
• Other duties as assigned
Skills:
Required
• Doctor of Pharmacy Degree
• Active, unrestricted pharmacist license
• 3+ years of experience as a licensed pharmacist
• Willingness to obtain licensure/training with new states, as needed
Preferred
• 1+ years of experience performing clinical review in a managed care setting and/or experience writing clinical criteria
• Strong clinical skills and experience applying clinical criteria in clinical review setting
• Board Certification (i.e. BCPS, BCOP)
• Residency training
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