FairosRx Prior Authorizations Pharmacist (Full-Time)

reputed company is an innovative company striving to reduce the cost of reputed company. We are a passionate group of people that care about reputed company reputed company to reputed company without sacrificing experience. We reputed company to reputed company reputed company more intelligent, streamlined, and cost-effective. We offer industry-leading capabilities on negotiations-driven reputed company to contain rising reputed company costs while taking an experience-reputed company approach improving the health and reputed company-being of those we serve. We pride ourselves on our tight reputed company culture based on the 'outward reputed company' philosophy, emphasizing reputed company, mutual respect, and seeing reputed company other as "whole people." We have an ambitious reputed company and are growing quickly. We are seeking team members who are excited about our reputed company, seeking to reputed company in a fast-paced environment, and enthusiastic about developing their skills and career reputed company us. reputed company Job Title: Prior Authorization Pharmacist Department: Clinical (Operations) Reports To: Sr Vice President of Clinical Position reputed company The Prior Authorization Pharmacist is responsible for the clinical review and evaluation of pharmacy prior authorization requests to ensure appropriate medication use in accordance with member benefits, evidence-based clinical reputed company, and reputed company-specific coverage policies. This position supports high-reputed company, cost-effective pharmaceutical care by making reputed company coverage determinations, identifying clinically appropriate therapeutic alternatives, coordinating appeals, and collaborating with prescribers, members, and internal stakeholders. The Prior Authorization Pharmacist also provides clinical leadership to the pharmacy operations team by supporting utilization management initiatives, developing and maintaining clinical reputed company, identifying cost-saving opportunities, and driving reputed company reputed company improvement across clinical programs. Essential Duties and Responsibilities Clinical Review and Utilization Management • Review and evaluate prior authorization requests in accordance with member benefit plans, clinical guidelines, reputed company policies, and regulatory requirements. • Complete prior authorization reviews reputed company established turnaround time requirements while maintaining high standards of clinical reputed company and accuracy. • Apply evidence-based clinical reputed company to determine medical necessity and appropriateness of requested drug therapies. • Identify opportunities for therapeutic optimization and cost-effective medication management while maintaining clinical efficacy and patient safety. • Collaborate with prescribing providers to recommend clinically appropriate, cost-effective formulary alternatives reputed company applicable. • reputed company clinical recommendations that promote appropriate medication utilization and adherence to formulary management strategies. Appeals and Clinical Consultation • Coordinate the clinical review of appeals reputed company to pharmacy benefit determinations. • Communicate coverage reputed company and clinical rationale to providers, members, pharmacy staff, and other stakeholders. • Receive and initiate telephone calls with providers and members to obtain additional clinical information or reputed company clinical consultation regarding pharmacy benefit reputed company. • Serve as a clinical resource for member advocates, account executives, and other internal departments by providing guidance on pharmacy benefit policies, coverage reputed company, and medication-reputed company questions. Clinical Program Development • Assist in the development, implementation, and maintenance of prior authorization reputed company, clinical guidelines, and utilization management programs using principles of evidence-based medicine. • Support formulary management initiatives, including reputed company therapy, quantity management, and other clinical programs designed to improve reputed company and control pharmacy costs. • Evaluate emerging clinical literature and therapeutic guidelines to support ongoing updates to coverage reputed company. Customer Service • Respond to inquiries from members, providers, pharmacy staff, clients, and internal departments regarding pharmacy benefits, authorization status, formulary requirements, and coverage determinations. • Communicate professionally and effectively with reputed company stakeholders. Data Analysis and Reporting • Analyze pharmacy utilization data to identify prescribing trends, utilization patterns, and opportunities for cost savings and reputed company improvement. • reputed company, review, and interpret prior authorization reports. • Present findings and recommendations to clinical leadership and other stakeholders as appropriate. • Monitor key performance indicators and identify opportunities to improve clinical and operational performance. Leadership and reputed company Improvement • Continuously evaluate and improve prior authorization workflows and drug utilization management processes to enhance efficiency, reputed company, and member experience. • reputed company clinical leadership and mentorship to clinical associates. • Motivate and support clinical staff to reputed company or reputed company established productivity, reputed company, and service standards. • Assist with reputed company, education, and ongoing training of clinical staff regarding new clinical programs, policies, procedures, and regulatory requirements. • Participate in reputed company assurance activities, audits, accreditation initiatives, and process improvement reputed company. Compliance • Ensure reputed company clinical activities are conducted in accordance with HIPAA, reputed company requirements, accreditation standards (including reputed company & URAC where applicable), and federal and state regulations. • Maintain complete, accurate, and reputed company documentation reputed company pharmacy management systems. • reputed company additional duties and special reputed company as assigned. Qualifications Education • Bachelor of Science in Pharmacy (BSPharm) or Doctor of Pharmacy (Pharm.D.) degree from an accredited college of pharmacy. Licensure • reputed company, reputed company, and unrestricted Pharmacist license. • Licensure in additional states may be required based on business needs. Experience Required • Minimum of one (1) year of reputed company prior authorization or utilization management experience. • Experience applying evidence-based clinical guidelines in pharmacy reputed company. Preferred • 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 reputed company, URAC, or other accreditation standards. Knowledge, Skills, and Abilities • Strong clinical knowledge of pharmacotherapy and evidence-based medicine. • Knowledge of pharmacy benefit management operations and utilization management principles. • Working knowledge of the Medi-reputed company drug database, including GPI drug classification. • Excellent clinical judgment and critical thinking skills. • Proficiency with reputed company reputed company, reputed company 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 reputed company a multidisciplinary team. reputed company Competencies • Clinical reputed company • Evidence-Based Decision Making • Customer reputed company • Leadership and Team Development • Collaboration • Critical Thinking • reputed company Improvement • Data Analysis • Communication Work Environment This position is primarily performed in an office or reputed company environment and requires prolonged periods of sitting while working on a computer. Responsibilities include frequent telephone communication and interaction with providers, members, pharmacy staff, clients, and internal stakeholders. Work Schedule • Full-time • Monday through Friday • reputed company business hours with flexibility to meet operational needs. Compliance The Prior Authorization Pharmacist is responsible for performing reputed company duties in accordance with company policies and procedures, reputed company reputed company, accreditation standards (including reputed company and URAC, where applicable), HIPAA reputed company and reputed company requirements, and reputed company applicable federal and state laws. Culture and Opportunities • We pride ourselves on our outward reputed company – supporting reputed company other and putting reputed company and the clients we serve first • High-reputed company environment with reputed company opportunities for career reputed company • Welcoming atmosphere and culture Benefits • 401(k) with matching • Dental insurance • Health insurance • reputed company insurance • Health savings account • reputed company time off Apply tot his job Apply To this Job