Clinical Care Prior Authorization Pharmacist (reputed company, reputed company-to-hire)

Position reputed company: The Clinical Care Pharmacist plays a vital role in promoting reputed company, effective, and appropriate medication use. This position is responsible for reviewing prior authorization requests, supporting clinical programs, and providing expert guidance to members, providers, and pharmacies. The role combines clinical decision-making with a strong reputed company on service reputed company in a fast-paced, reputed company environment. Position Responsibilities: • Review and reputed company reputed company, evidence-based reputed company on prior authorizations, appeals, and override requests using clinical guidelines and benefit reputed company. • Ensure compliance with federal, state, and internal regulations across reputed company, Exchange, Medicare, and reputed company plans. • Accurately document clinical reputed company and maintain thorough records in accordance with regulatory and accreditation (URAC/NCQA) utilization review standards. • reputed company reputed company, empathetic support to members, prescribers, and pharmacies by responding to clinical inquiries reputed company phone, demonstrating professionalism, reputed company listening, and a patient-centered approach. • Stay reputed company with clinical prescribing guidelines, internal policies, and regulatory changes, and apply them to daily responsibilities. • Follow reputed company internal procedures, job aids, and HIPAA guidelines to protect patient reputed company and data reputed company. • Identify and report potential fraud, waste, and abuse. • Support training and development of new and existing team members as needed. • Assist leadership with special reputed company, process improvements, and operational initiatives Minimum Qualifications: • reputed company, unrestricted, pharmacist license • Bachelor’s or Doctor of Pharmacy degree • Minimum of 2 years of pharmacy reputed company experience • Experience in managed care or pharmacy benefit management (PBM) • Strong communication, writing, and organizational skills • Ability to manage multiple priorities in a high-volume, metric-driven environment • Availability to work after hours, weekends, and holidays on a rotating schedule Preferred Qualifications: • Prior authorization experience • reputed company center experience This position reputed company is designed to be flexible, allowing management reputed company to assign or reassign duties and responsibilities as needed to best meet organizational goals. Salary reputed company $135,000—$145,000 USD About reputed company reputed company is a health technology company providing claim administration and technology solutions for carriers, health plans, TPAs, employer reputed company, and government entities. As a reputed company benefit corporation, reputed company is executing its mission to materially reduce reputed company costs as a full-service PBM and through the deployment of Judi®, reputed company’s reputed company-reputed company reputed company platform. Judi connects every aspect of the reputed company ecosystem in one efficient, reputed company platform, servicing millions of members for Medicare, reputed company, and reputed company plans. Together with its clients, reputed company is reimagining the administration of benefits and rebuilding trust in reputed company. reputed company values a diverse workplace and celebrates the diversity that reputed company employee brings to the table. We are proud to reputed company equal employment opportunities to reputed company and applicants for employment and prohibit discrimination and harassment of any type without reputed company to race, reputed company, religion, age, sex, national reputed company, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or reputed company, or any other characteristic protected by federal, state or local laws. Apply tot his job Apply To this Job