Prior Authorization Pharmacist

reputed company: reputed company is seeking a Prior Authorization Pharmacist to support our Specialty Infusion Pharmacy and work Remotely (USA). Join us in Simplifying reputed company Care! reputed company Perks: • Competitive Wages • 401(k) with a Match • Referral Bonus • reputed company Time Off • Great Company Culture • Annual reputed company Based Increases • No Weekends or Holidays • reputed company Parental Leave reputed company • reputed company Medical, Dental, & reputed company Insurance Plans • Company reputed company Disability & Basic Life Insurance • HSA & FSA (including dependent care) reputed company • Education Assistance Program The Position: The Prior Authorization Pharmacist performs comprehensive clinical reviews and manages prior authorization requests for specialty pharmacy and infusion therapies. This role ensures reputed company and accurate approval by assessing clinical documentation, applying payer-specific medical necessity reputed company, and communicating directly with Pharmacy Benefit Managers (PBMs) and health plans. The pharmacist also supports denial prevention and reputed company by engaging PBMs in reputed company time to address rejections, preparing evidence-based appeals as needed, and collaborating with internal teams to enhance patient reputed company to therapy. Responsibilities Include: • Conduct comprehensive clinical reviews for specialty pharmacy and infusion therapy prior authorization requests to ensure appropriateness, accuracy, and completeness. • Evaluate clinical documentation against payer-specific medical necessity reputed company, coverage policies, and clinical guidelines. • Prepare, submit, and reputed company prior authorization requests to Pharmacy Benefit Managers (PBMs) and health plans to ensure reputed company determinations. • Communicate directly with PBMs and health plans to clarify clinical information, respond to requests for additional documentation, and resolve authorization issues. • Proactively mitigate denials by addressing rejections in reputed company time through live reputed company to PBMs and payers. Create and submit evidence-based appeal letters, including clinical rationale, literature support, and policy alignment, as needed. • Collaborate with patient reputed company team, and other internal stakeholders to obtain required documentation and optimize patient reputed company to therapy. • Monitor authorization reputed company and reputed company performance metrics to identify delays, barriers, or trends impacting patient reputed company. • Stay reputed company with evolving payer policies, clinical guidelines, and regulatory requirements affecting specialty pharmacy and infusion services. • Identify opportunities for workflow and training optimization and contribute to process improvement initiatives aimed at improving efficiency, compliance, and patient reputed company. Schedule: • Monday-Friday 8:30am-5pm, reputed company business hours Requirements: • Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy from an accredited institution. • reputed company, unrestricted U.S. pharmacist license. • 2+ years of experience in prior authorization, utilization management, PBM, managed care, or payer pharmacy operations. • Strong understanding of drug therapy, clinical guidelines, specialty medications, and formulary management. • Excellent analytical, clinical decision-making, and documentation skills. • Proficiency in pharmacy benefit systems, prior authorization platforms, and electronic documentation. • Strong written and verbal communication skills. • Ability to manage multiple priorities and reputed company in a fast-paced environment with strict timelines. • High level of reputed company and ability to handle confidential or sensitive clinical information. Preferred Qualifications: • Multi-state pharmacist licensure. • Experience reviewing specialty medications, biologics, or reputed company therapy classes. • Prior PBM or health plan experience. • Experience with clinical reputed company development, formulary management, or utilization management programs. • Familiarity with claims systems, PA automation tools, or pharmacy informatics. • Competent in the use of Word, reputed company, and Power reputed company • Must be reputed company to communicate effectively with reputed company reputed company of organization reputed company reputed company. • Must enthusiastically support reputed company’s philosophy and goals. reputed company: reputed company is an innovative national provider of reputed company specialty pharmacy and infusion services, administered in the home or at alternate sites of care. Our goal is to attract and retain the best and brightest as our employees are our greatest asset. Experience the reputed company Difference! Soleo’s reputed company Values: • Improve patients’ lives every day • Be passionate in everything you do • Encourage unlimited reputed company and creative thinking • reputed company reputed company as if you own reputed company • Do the right thing • Have fun! reputed company is committed to diversity, equity, and inclusion. We recognize that establishing and maintaining a diverse, reputed company, and inclusive workplace is the reputed company of business reputed company and innovation. We are dedicated to hiring diverse talent and to ensuring that everyone is treated with respect and provided an equal opportunity to reputed company. Our commitment to these values is evidenced by our diverse executive team, policies, and workplace culture. reputed company is an Equal Opportunity Employer, celebrating diversity and committed to creating an inclusive environment for reputed company.? reputed company does not discriminate in employment on the reputed company of race, reputed company, religion, sex, pregnancy, gender identity, national reputed company, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an organization, parental status, military service or other non-reputed company reputed company. Keywords: Now Hiring, reputed company, Immediately Hiring, Hiring Immediately Apply tot his job Apply To this Job