Prior Authorization (PA) Pharmacist
A PA pharmacist is the one who decides whether a prescribed device, procedure, service, or medication will be covered and paid for. This individual may oversee the incoming patient order process, collect vital documents and contact the physician's office for additional information, determine whether the order is likely to be approved (pre-pre-authorization) and complete payment approval from insurance, Medicare, and/or Medicaid prior to scheduling order.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Provide utilization management for drug therapies including; review of prior authorization requests to make determinations for drug therapy according to member benefits and coverage criteria, creation and maintenance of Pharmacy and Medical drug therapy guidelines, development of clinical criteria for review of non-formulary or non-preferred drug requests, and determination and maintenance of applicable prescription limitations (age, gender, quantity, etc.)
- Work adhering to US regulatory and Quality System requirements (21 CFR 820, etc).
- This position assumes and performs other duties as assigned.
QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:
- 2+ years of prior PA experience
EDUCATION and/or EXPERIENCE
- Doctoral degree (PharmD) or equivalent; or more than 10 years related experience and/or training; or equivalent combination of education and experience.
CERTIFICATES, LICENSES, REGISTRATIONS
- Active, current and unrestricted State of Texas (a state in the United States) pharmacist license