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Job description
Title: Prior Authorization Pharmacist (R)Location : Remote - ESTContract Length: 13 Weeks (Possible Extension)Shift: EST / (8hrs.*5 days) Business HoursJob Summary: We are seeking a licensed Pharmacist to join our Prior Authorization Department. The Pharmacist will review prior authorization requests, make coverage and medical-necessity determinations, and ensure decisions align with clinical guidelines, regulations, and established criteria.Job Duties: Review and process prior authorization requests for pharmaceutical products.
Make medical necessities and benefit determinations using established criteria and pharmacy guidelines.
Provide clinical support to the Perform Rx Customer Care Center.
Communicate with providers to obtain information and support appropriate determinations.
Support Fraud and Abuse program oversight and related clinical activities.
Stay current with industry trends, regulatory changes, operational directives, and customer-specific reference materials.
Requirements: Active Pharmacist license
PharmD or equivalent pharmacy qualification.
Recent 1 year of Prior Authorization or Coverage Determination experience is required.
Flexibility to work a rotating weekend schedule if required by business needs.
Worksite address
philadelphia, PA, 19117, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.