Durham, NC · On-site
$114K - $136K/yr
The Prior Authorization Clinical Pharmacist is responsible for evaluating and managing the selection and utilization of pharmaceuticals to ensure safe, effective, and cost-efficient medication use.
Durham, NC · On-site
$114K - $136K/yr
The Prior Authorization Clinical Pharmacist is responsible for evaluating and managing the selection and utilization of pharmaceuticals to ensure safe, effective, and cost-efficient medication use.
Durham, NC · On-site
$107K - $128K/yr
The Prior Authorization Clinical Pharmacist is responsible for evaluating and managing the selection and utilization of pharmaceuticals to ensure safe, effective, and cost-efficient medication use.
Durham, NC · On-site
$107K - $128K/yr
The Prior Authorization Clinical Pharmacist is responsible for evaluating and managing the selection and utilization of pharmaceuticals to ensure safe, effective, and cost-efficient medication use.
$114K - $136K/yr
The Prior Authorization Clinical Pharmacist is responsible for evaluating and managing the selection and utilization of pharmaceuticals to ensure safe, effective, and cost-efficient medication use.
$114K - $136K/yr
The Prior Authorization Clinical Pharmacist is responsible for evaluating and managing the selection and utilization of pharmaceuticals to ensure safe, effective, and cost-efficient medication use.
Raleigh, NC · On-site
$16 - $21.25/hr
... management system.. Key Responsibilities * Obtain prior authorizations and pre-certifications for medications, procedures, and specialty services * Verify insurance benefits and identify ...
Raleigh, NC · On-site
$16 - $21.25/hr
... management system.. Key Responsibilities * Obtain prior authorizations and pre-certifications for medications, procedures, and specialty services * Verify insurance benefits and identify ...
Cary, NC · Hybrid
$17.25 - $21/hr
Pharmacy Technician This role focuses on managing end-to-end prior authorization and insurance verification processes for specialty medications, ensuring patients gain timely access to therapy while ...
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Cary, NC · Hybrid
$17.25 - $21/hr
Pharmacy Technician This role focuses on managing end-to-end prior authorization and insurance verification processes for specialty medications, ensuring patients gain timely access to therapy while ...
Raleigh, NC · On-site
$115K - $137K/yr
Reviews a completed prior authorization request received from the provider and/or reviews the ... Some experience working in managed care, understanding of Medicare/Medicaid law Disqualifiers: n/a ...
Raleigh, NC · On-site
$115K - $137K/yr
Reviews a completed prior authorization request received from the provider and/or reviews the ... Some experience working in managed care, understanding of Medicare/Medicaid law Disqualifiers: n/a ...
Smithfield, NC · On-site +1
$20.73 - $26.43/hr
Triage, process, and gather clinical information to build prior authorization requests that are ... Knowledge of office management, including the ability to organize workflow and coordinate ...
Smithfield, NC · On-site +1
$20.73 - $26.43/hr
Triage, process, and gather clinical information to build prior authorization requests that are ... Knowledge of office management, including the ability to organize workflow and coordinate ...
Morrisville, NC · On-site +1
$20.73 - $26.43/hr
Triage, process, and gather clinical information to build prior authorization requests that are ... Knowledge of office management, including the ability to organize workflow and coordinate ...
Morrisville, NC · On-site +1
$20.73 - $26.43/hr
Triage, process, and gather clinical information to build prior authorization requests that are ... Knowledge of office management, including the ability to organize workflow and coordinate ...
Morrisville, NC · On-site +1
$20.73 - $26.43/hr
Triage, process, and gather clinical information to build prior authorization requests that are ... Knowledge of office management, including the ability to organize workflow and coordinate ...
Morrisville, NC · On-site +1
$20.73 - $26.43/hr
Triage, process, and gather clinical information to build prior authorization requests that are ... Knowledge of office management, including the ability to organize workflow and coordinate ...
Raleigh, NC · On-site
$20.73 - $31.58/hr
... manager's discretion. Preferred Qualifications * 3 years of experience preferred. * Refill authorization experience. * Prior health system or retail experience * Familiarity with top 100 most common ...
New
Raleigh, NC · On-site
$20.73 - $31.58/hr
... manager's discretion. Preferred Qualifications * 3 years of experience preferred. * Refill authorization experience. * Prior health system or retail experience * Familiarity with top 100 most common ...
New
Durham, NC · On-site
The scope of prior authorization and medical necessity includes, but is not limited to, inpatient and outpatient surgical services and admissions. The manager is also responsible for the oversight of ...
Durham, NC · On-site
The scope of prior authorization and medical necessity includes, but is not limited to, inpatient and outpatient surgical services and admissions. The manager is also responsible for the oversight of ...
Durham, NC · On-site
The scope of prior authorization and medical necessity includes, but is not limited to, inpatient and outpatient surgical services and admissions. The manager is also responsible for the oversight of ...
Durham, NC · On-site
The scope of prior authorization and medical necessity includes, but is not limited to, inpatient and outpatient surgical services and admissions. The manager is also responsible for the oversight of ...
Durham, NC · On-site
The scope of prior authorization and medical necessity includes, but is not limited to, inpatient and outpatient surgical services and admissions. The manager is also responsible for the oversight of ...
Durham, NC · On-site
The scope of prior authorization and medical necessity includes, but is not limited to, inpatient and outpatient surgical services and admissions. The manager is also responsible for the oversight of ...
Raleigh, NC · On-site
$20.73 - $31.58/hr
... manager's discretion. Preferred Qualifications * 3 years of experience preferred. * Refill authorization experience. * Prior health system or retail experience * Familiarity with top 100 most common ...
Raleigh, NC · On-site
$20.73 - $31.58/hr
... manager's discretion. Preferred Qualifications * 3 years of experience preferred. * Refill authorization experience. * Prior health system or retail experience * Familiarity with top 100 most common ...
Durham, NC · On-site
The scope of prior authorization and medical necessity includes, but is not limited to, inpatient and outpatient surgical services and admissions. The manager is also responsible for the oversight of ...
Durham, NC · On-site
The scope of prior authorization and medical necessity includes, but is not limited to, inpatient and outpatient surgical services and admissions. The manager is also responsible for the oversight of ...
Cary, NC · Hybrid
$23 - $24/hr
Communicate the need for medication prior authorization (PA) to providers and serve as a resource to the provider during the PA process. * Manage inbound calls from patients, clients, physicians ...
Cary, NC · Hybrid
$23 - $24/hr
Communicate the need for medication prior authorization (PA) to providers and serve as a resource to the provider during the PA process. * Manage inbound calls from patients, clients, physicians ...
Cary, NC · Hybrid
$17.99 - $29.98/hr
In this role, you will support prior authorizations, reimbursement activities, financial assistance ... Manage inbound calls from patients, clients, physicians, practitioners, and clinics regarding ...
Cary, NC · Hybrid
$17.99 - $29.98/hr
In this role, you will support prior authorizations, reimbursement activities, financial assistance ... Manage inbound calls from patients, clients, physicians, practitioners, and clinics regarding ...
Cary, NC · Hybrid
$23 - $24/hr
Communicate the need for medication prior authorization (PA) to providers and serve as a resource to the provider during the PA process. * Manage inbound calls from patients, clients, physicians ...
Cary, NC · Hybrid
$23 - $24/hr
Communicate the need for medication prior authorization (PA) to providers and serve as a resource to the provider during the PA process. * Manage inbound calls from patients, clients, physicians ...
Cary, NC · On-site
$23 - $24/hr
Communicate the need for medication prior authorization (PA) to providers and serve as a resource to the provider during the PA process. * Manage inbound calls from patients, clients, physicians ...
Cary, NC · On-site
$23 - $24/hr
Communicate the need for medication prior authorization (PA) to providers and serve as a resource to the provider during the PA process. * Manage inbound calls from patients, clients, physicians ...
Cary, NC · Hybrid
$17.99 - $29.98/hr
In this role, you will support prior authorizations, reimbursement activities, financial assistance ... Manage inbound calls from patients, clients, physicians, practitioners, and clinics regarding ...
Cary, NC · Hybrid
$17.99 - $29.98/hr
In this role, you will support prior authorizations, reimbursement activities, financial assistance ... Manage inbound calls from patients, clients, physicians, practitioners, and clinics regarding ...
$30.6K - $41.1K
9% of jobs
$41.1K - $51.6K
13% of jobs
$55.7K is the 25th percentile. Wages below this are outliers.
$51.6K - $62K
7% of jobs
$62K - $72.5K
17% of jobs
The median wage is $74.7K / yr.
$72.5K - $83K
18% of jobs
$83K - $93.5K
7% of jobs
$96.9K is the 75th percentile. Wages above this are outliers.
$93.5K - $103.9K
11% of jobs
$103.9K - $114.4K
5% of jobs
$114.4K - $124.9K
5% of jobs
$124.9K - $135.3K
3% of jobs
$135.3K - $145.8K
4% of jobs
$30.6K
$81.2K
$145.8K
A Manager of Prior Authorization oversees the authorization process for medical treatments, ensuring that required approvals are obtained from insurance providers. They manage a team handling prior authorization requests, review policies to ensure compliance, and work to optimize efficiency in approval processes. This role involves collaboration with healthcare providers, insurance companies, and patients to minimize delays in care. Strong leadership, knowledge of insurance guidelines, and experience in healthcare administration are essential for success in this position.
A Manager Prior Authorization often encounters challenges such as managing high volumes of authorization requests, staying updated with changing insurance requirements, and ensuring quick turnaround times to avoid delays in patient care. Addressing these issues typically involves implementing efficient workflows, training staff on the latest policies, and leveraging technology to automate repetitive tasks. Collaboration with physicians, payers, and internal departments is also key to resolving complex authorization cases. Proactive communication and continuous process improvement help maintain compliance and streamline the overall prior authorization process.
To excel as a Manager Prior Authorization, you need expertise in healthcare administration, insurance processes, and prior authorization protocols, usually demonstrated by a bachelor's degree in healthcare or related fields and relevant experience. Familiarity with healthcare management software, electronic medical records (EMR), and insurance authorization systems is highly valuable, and certifications like Certified Prior Authorization Specialist (CPAS) can be advantageous. Outstanding leadership, attention to detail, and effective communication are pivotal for managing teams and streamlining workflows. These skills and qualities ensure compliance, reduce delays in patient care, and improve overall operational efficiency within healthcare organizations.
$114K - $136K/yr
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Re-posted 8 days ago
7.7
Based on 349 frontline employees who took The Breakroom Quiz
201st of 303 rated insurance
Anticipated End Date:
2026-08-10Position Title:
Prior Authorization Clinical PharmacistJob Description:
Prior Authorization Clinical Pharmacist
Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The Prior Authorization Clinical Pharmacist is responsible for evaluating and managing the selection and utilization of pharmaceuticals to ensure safe, effective, and cost-efficient medication use. This role supports key clinical pharmacy programs, including Drug Utilization Review (DUR), Drug Information Services (DIS), and formulary management.
How you will make an impact:
Researches and synthesizes detailed clinical data related to pharmaceuticals.
Prepares and presents therapeutic class reviews and drug monograph information to the Pharmacy and Therapeutics Committee.
May review and approve or deny coverage for pharmaceuticals (as permitted by state/federal law or state/federal program contracts) based on medical necessity criteria, and coordinates with internal stakeholders or health plan medical directors as needed.
Serves as a clinical resource to other pharmacists on areas such as prospective, inpatient and retrospective DURs and provides dosage conversion and clinical support for therapeutic interventions.
Prepares information for network physicians.
Prepares and presents therapeutic class reviews and drug monographs to the Pharmacy and Therapeutics (P&T) Committee.
Provides clinical guidance for therapeutic interventions, dosage conversions, and evidence-based medication use.
Develops and communicates drug information and recommendations to network physicians and clinical teams.
Minimum Requirements:
Requires BA/BS in Pharmacy.
Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience; or any combination of education and experience, which would provide an equivalent background.
Requires a registered pharmacist.
Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh).
For associates working within Puerto Rico who are member or patient facing either in a clinical setting or in the Best Transportation unit, a current PR health certificate and a current PR Law 300 certificate are required for this position.
Preferred Skills, Capabilities and Experiences:
Active North Carolina Pharmacist (RPh) license.
Prior Authorization experience supporting NC Medicaid, Commercial, and Specialty Medicaid pharmacy programs preferred.
Knowledge of Medicaid and Commercial pharmacy benefit management processes.
Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US, unless they are command-sanctioned activities.
For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Job Level:
Non-Management ExemptWorkshift:
Job Family:
MED > Licensed/Registered Pharmacist/Pharmacy TechnicianPlease be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.
NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words - the job is posted until 3/13, not through 3/13.
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Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
Health care and social assistance
10,000+ Employees
Indianapolis, IN, US
2004
