Pharmacist Operations AdvisorRose International • Atlanta, GA, US
Pharmacist Operations Advisor
Rose International • Atlanta, GA, US
27 days ago
Job type
- Full-time
- Temporary
Job descriptionBachelor’s Degree – BS Pharmacy Active pharmacist license in the state of practice / residence. Doctorate – PharmD. Active pharmacist license. Prior experience with prior authorization (PA) reviews or clinical case review in a high-volume or production setting Direct experience processing PA requests, ideally with a commercial or specialty pharmacy Strong documentation of meeting service level agreements (SLAs) or production targets Ability to multitask using multiple technology platforms and clinical resources Proficiency with Microsoft Office (Excel and Word) Experience using multiple clinical and administrative systems simultaneously Effective written and verbal communication skills Ability to collaborate with cross-functional clinical and non-clinical staff Comfort handling phone-based interactions with providers and patients. Retail pharmacy experience (not required, but candidates with this background have been successful in the role). Operation-based role that conducts criteria-based and clinical review of medical data for prior authorization in alignment with policy and procedure Applies clinical knowledge to plan and approve criteria for case reviews Works within Client-supported systems to handle inbound calls from physicians or members regarding pending, approved, or denied prior authorizations Provides internal support to the Prior Authorization team and the Member Services department Provides on-call, after-hours availability for urgent prior authorization requests as needed Position is remote, available to candidates anywhere in the continental U.S. except New Mexico and Colorado Requires a broadband internet connection and a smartphone Evaluate and review prior authorization requests, render coverage determinations based on clinical criteria, and plan design Verify insurance coverage and eligibility, interpret clinical guideline criteria, and consult with healthcare providers Communicate approval and denial decisions promptly to providers, employers, patients, and other stakeholders Collaborate with technicians and team members to process referrals, answer clinical questions, and collect required data Handle inbound / outbound calls to facilitate requests, answer inquiries, and resolve escalations Maintain professional and technical knowledge of drug and disease states for specialty and non-specialty programs Attend training sessions, development meetings, and provide after-hours / on-call support as required Perform other related duties as assigned. Regular and predictable attendance Ability to work mandatory overtime or extended work weeks as needed Compliance with departmental, company, state, and federal requirements Adherence to policies and procedures Ongoing participation in training and development meetings. Only those lawfully authorized to work in the designated country associated with the position will be considered. Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.
Date Posted : 09 / 03 / 2025
Hiring Organization : Rose International
Position Number : 487989
Industry : Pharmaceutical / Healthcare
Job Title : Pharmacist Operations Advisor
Job Location : Remote, USA
Work Model : Remote
Shift :
Sunday to Thursday or Tuesday to Saturday
10 : 30 AM to 7 : 00 PM CST
Employment Type : Temporary
FT / PT : Full-Time
Estimated Duration (In months) : 7
Min Hourly Rate ($) : 50.00
Max Hourly Rate ($) : 53.00
Must Have Skills / Attributes : Clinical Data management, Microsoft Excel, Microsoft Word, Pharmacy
Experience Desired : Experience with prior authorization (PA) reviews or clinical case review (2+ yrs); Active pharmacist license in the state of practice / residence (1+ yrs)
Required Minimum Education : Bachelor’s Degree
Preferred Education : Ph.D. / Doctorate
Required Certifications / Licenses : Pharmacist license
- C2C is not available
Job Description
Required Education
Preferred Education
Required License / Certification
Required Qualifications / Skills / Experience
Preferred Qualifications / Skills / Experience
Pharmacist / Clinician Overview
Job Duties
Essential Functions
Benefits :
For information and details on employment benefits offered with this position, please visit here. Should you have any questions / concerns, please contact our HR Department via our secure website.
California Pay Equity :
For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations' website here.
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Pharmacist • Atlanta, GA, US
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