International Prior Authorization Jobs (NOW HIRING)

Required Education• Bachelor's degree in pharmacy (BS Pharmacy)Preferred Education• Doctorate in Pharmacy (PharmD)Required License/Certification• Active pharmacist license in the state of residenceRequired Qualifications/Skills/Experience• 1–3 years of prior work experience as a pharmacist• 2 years in prior authorization• Ability to evaluate and review prior authorization requests using clinical criteria and plan design• Ability to interpret clinical guideline criteria and apply clinical knowledge and resources appropriately• Ability to collaborate with physicians, healthcare providers, technicians, prior authorization team members, patients, health plans, and employers• Ability to collect and evaluate appropriate clinical and medical data• Ability to handle inbound and outbound calls and resolve escalations• Ability to meet designated service level agreements (SLAs)• Ability to comply with department protocols and approval and denial management processes• Basic computer skillsPreferred Qualifications/Skills/Experience• 3–5 years of prior work experience in prior authorization• Previous pharmacy experience in a pharmacy benefit manager (PBM) environment• Knowledge of drug and disease states for Specialty and Non-Specialty Pharmacy programsPharmacist Overview• The Pharmacist/Clinician is an operations-based role responsible for conducting criteria-based and clinical reviews of medical data to perform prior authorization determinations in accordance with established policies and procedures• Applies clinical knowledge and approved criteria to review cases and make appropriate coverage determinations• Works within supported pharmacy and clinical systems to review pending prior authorizations and communicate with physicians, healthcare providers, and members regarding approved or denied requests• Collaborates with the Prior Authorization team and Member Services to answer clinical questions, obtain necessary medical information, and resolve escalations• Maintains professional and technical knowledge of drug and disease states across Specialty and Non-Specialty Pharmacy programs• Provides on-call and after-hours pharmacist availability for urgent prior authorization requests as neededJob Duties• Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design• Verify insurance coverage and eligibility and interpret applicable clinical guideline criteria• Consult with physicians and other healthcare providers as needed and appropriately utilize clinical knowledge and resources while complying with department protocols• Communicate case decisions promptly and efficiently to healthcare providers, health plans/employers, patients, and other healthcare professionals in accordance with established approval and denial management processes• Collaborate with technicians and Prior Authorization team members to process referrals• Answer clinical questions and collect appropriate clinical and medical data needed to perform clinical assessments and reviews according to health plan/employer-agreed criteria and designated SLAs• Handle inbound and outbound phone calls with technicians, Prior Authorization team members, physicians, healthcare providers, and patients to facilitate prior authorization requests, answer inquiries, and resolve escalations• Maintain professional and technical knowledge of drug and disease states for Specialty and Non-Specialty Pharmacy programs administered within the Commercial Specialty line of business• Attend training sessions and development meetings• Provide on-call and after-hours pharmacist availability as needed

**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.**