Prior Authorization Pharmacist

Curant Health

$90K — $120K *
Healthcare
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • Doctor of Pharmacy (PharmD) with at least 2 years of relevant experience.
  • Licensed to practice in the state of Georgia.
  • Prior experience in prior authorizations and clinical pharmacy preferred.
  • Familiarity with PBM, formulary management, and 340B beneficial.
  • Strong understanding of clinical criteria and medication management.

Responsibilities

  • Review and process prior authorization requests based on specific clinical criteria.
  • Coordinate drug utilization reviews ensuring regulatory compliance.
  • Handle clinical inquiries from Customer Care regarding medication prior authorizations.
  • Manage appeals for prior authorizations while adhering to established policies.
  • Serve as a clinical resource for internal stakeholders, prescribers, and clients.
  • Monitor and enhance the quality and efficiency of the Coverage Determination process.
  • Stay current on clinical guidelines to inform program development and training.
  • Supervise the Prior Authorization Department, focusing on operational effectiveness and staff training.

Benefits

  • Competitive pay and paid holidays.
  • Comprehensive health benefits and paid time off.
  • Work/life balance initiatives and paid parental leave.
  • Recognition programs and opportunities for advancement.
  • Comprehensive training program for career development and employee prescription discounts.
Full Job Description
Curant Health is searching for a Prior Authorization Pharmacist to join its team in Smyrna, GA. The Prior Authorization Pharmacist oversees clinical and operational aspects of specialty medication prior authorizations. This role involves processing and evaluating PA requests, supervising PA specialists, and serving as a clinical resource to both internal and external stakeholders. Key Responsibilities: - Review and process prior authorization requests based on clinical criteria and member benefits. - Coordinate drug utilization review reports and ensure compliance with regulatory requirements. - Handle clinical calls from Customer Care for medication-related prior authorizations. - Manage PA appeals and ensure adherence to policies and procedures. - Act as a clinical resource for internal teams, prescribers, and clients. - Monitor and improve the quality and efficiency of the Coverage Determination process. - Stay updated on clinical guidelines and provide relevant insights for program development. - Supervise the Prior Authorization Department, ensuring operational efficiency and training. - Develop and implement departmental protocols and training materials. Qualifications: - Doctor of Pharmacy (PharmD) with at least 2 years of experience and licensed in the state of practice. - Prior experience with prior authorizations, clinical pharmacy, and managed care is preferred. - Knowledge of PBM, formulary management, and 340B is a plus. Why Work for Us? We offer competitive pay, paid holidays, benefits, paid time off and a work/life balance. Not only that, but we also offer paid parental leave, recognition programs, promotion opportunities, a comprehensive training program to enhance your career, and employee prescription discounts.

Similar Jobs

More Jobs at Curant Health

More Healthcare Jobs

Find similar Prior Authorization Pharmacist jobs: