Prior Authorization Pharmacist

This individual must have excellent interpersonal skills. Will be responsible for : reviewing patient profile, drug interactions, sensitivities and drug usage database in relation to patient's prescription. Determines if prescription requires physician clarification or if it should be forwarded to therapeutic intervention or doctor phone calls for follow-up. Enters prescription in to the computer. Assists in patient services as required, taking incoming prescription medication questions / concerns from patients. Assists in the doctor phone call area and / or therapeutic intervention as assigned and contacts physicians to resolve any questions or concerns. Maintains established procedures concerning quality assurance, security of controlled substances, and disposal of hazardous waste drugs. Works with other members of the pharmacy to ensure accuracy of prescriptions. Dispenses prescription medication and performs final dispensing quality check on all prescriptions for accuracy and dosage.

Prior experience with prior authorization (PA) reviews or clinical case review in a high-volume or production setting—look for direct experience processing PA requests, ideally with commercial or specialty pharmacy, and strong documentation of meeting service level agreements (SLAs) or production targets.

Demonstrated ability to multitask using multiple technology platforms and clinical resources—seek candidates who highlight comfort with multitasking, proficiency with Microsoft Office (especially Excel and Word), and using multiple clinical and administrative systems at once.

Strong communication and collaboration skills in cross-functional teams—prioritize resumes that show effective written and verbal communication, experience working with both clinical and non-clinical staff, and handling phone-based interactions with providers and patients.