Prior Authorizations Pharmacist
FairosRx
WorldwideFully remoteFull TimeHealthcare & Telemedicine
No salary statedPosted 23 days ago3w ago
Why we think you can apply
- Hiring model
- Open worldwide · the employer states no country restriction
- Work from
- Anywhere, the UAE included
Posted 23 days ago
About the role
Responsibilities
- Review and evaluate prior authorization requests in accordance with member benefit plans and clinical guidelines
- Identify opportunities for therapeutic optimization and cost-effective medication management
- Coordinate the clinical review of appeals related to pharmacy benefit determinations
- Communicate coverage decisions and clinical rationale to providers and members
- Assist in the development and maintenance of prior authorization criteria and clinical guidelines
- Analyze pharmacy utilization data to identify prescribing trends and cost savings
- Provide clinical leadership and mentorship to clinical associates
- Ensure compliance with HIPAA and accreditation standards
Requirements
- Bachelor of Science in Pharmacy (BSPharm) or Doctor of Pharmacy (Pharm.D.) degree
- Active, current, and unrestricted Pharmacist license
- Minimum of one year of direct prior authorization or utilization management experience
- Experience applying evidence-based clinical guidelines in pharmacy practice
Preferred Qualifications
- Pharmacy Benefit Management (PBM) experience
- Experience reviewing pharmacy prior authorizations and appeals
- Experience with formulary management and drug utilization review (DUR)
- Experience supporting NCQA or URAC accreditation standards
Benefits
- 401(k) with matching
- Dental insurance
- Health insurance
- Vision insurance
- Health savings account
- Paid time off
What we look for
- BSPharm or Pharm.D. degree
- Active, current, and unrestricted Pharmacist license
- Minimum 1 year of prior authorization or utilization management experience
- Experience applying evidence-based clinical guidelines
HealthcareClinical ReviewCase management
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FairosRx
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