Job Description
Our Client, a Retail Pharmacy company, is looking for a Clinical Pharmacist - Prior Authorization for their Remote location. Responsibilities:
+ Review, assess, adjudicate medication prior authorization requests for medical necessity, clinic...>al appropriateness, and formulary compliance.
+ Apply evidence-based clinical guidelines, drug compendia, FDA labeling, and plan-specific criteria to authorization decisions.
+ Evaluate patient-specific factors including diagnosis, laboratory results, prior therapy, dosing, contraindications, and comorbid conditions.
+ Authorize, modify, or deny medication requests and document clinical rationale clearly and accurately.
+ Collaborate with pharmacy technicians, nurses, medical directors, and other clinical staff to resolve complex cases.
+ Support peer-to-peer reviews and prepare clinical summaries when escalation is required.
+ Ensure compliance with state and federal reg...
+ Review, assess, adjudicate medication prior authorization requests for medical necessity, clinic...>al appropriateness, and formulary compliance.
+ Apply evidence-based clinical guidelines, drug compendia, FDA labeling, and plan-specific criteria to authorization decisions.
+ Evaluate patient-specific factors including diagnosis, laboratory results, prior therapy, dosing, contraindications, and comorbid conditions.
+ Authorize, modify, or deny medication requests and document clinical rationale clearly and accurately.
+ Collaborate with pharmacy technicians, nurses, medical directors, and other clinical staff to resolve complex cases.
+ Support peer-to-peer reviews and prepare clinical summaries when escalation is required.
+ Ensure compliance with state and federal reg...