FairosRx Prior Authorizations Pharmacist (Full-Time)
RemoteAmarillo, Texas, United States
Amarillo, Texas, United StatesRemoteFull TimeDoctorate Or Professional DegreeMedium
Full TimeDoctorate Or Professional DegreeMedium
Job Summary
Review and evaluate pharmacy prior authorization requests against member benefits, clinical guidelines, and coverage policies to ensure appropriate medication use. Complete reviews within established turnaround times while identifying therapeutic alternatives and coordinating appeals. Collaborate with prescribers, members, and stakeholders to provide clinical consultation and communicate coverage determinations. Develop and maintain utilization management programs, analyze pharmacy data for cost-saving opportunities, and mentor clinical associates. Ensure all activities comply with HIPAA, NCQA, and URAC standards.
Required Qualifications
- Bachelor of Science in Pharmacy (BSPharm) or Doctor of Pharmacy (Pharm.D.) degree from an accredited college of pharmacy
- Active, current, and unrestricted Pharmacist license
- Minimum of one (1) year of direct prior authorization or utilization management experience
- Experience applying evidence-based clinical guidelines in pharmacy practice
- Strong clinical knowledge of pharmacotherapy and evidence-based medicine
- Knowledge of pharmacy benefit management operations and utilization management principles
- Working knowledge of the Medi-Span drug database, including GPI drug classification
- Excellent clinical judgment and critical thinking skills
- Proficiency with Microsoft Excel, Microsoft Word, and pharmacy management systems
- Excellent written and verbal communication skills
- Strong interpersonal and customer service skills with the ability to effectively communicate with providers, clients, members, and internal stakeholders
- Strong organizational skills and the ability to prioritize multiple competing responsibilities while meeting established deadlines
- Ability to work independently and collaboratively within a multidisciplinary team
- Monday through Friday
- Standard business hours with flexibility to meet operational needs
Desired Qualifications
- Pharmacy Benefit Management (PBM) experience
- Experience reviewing pharmacy prior authorizations and appeals
- Experience with formulary management, drug utilization review (DUR), and medication therapy management
- Experience supporting NCQA, URAC, or other accreditation standards
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