Clinical Pharmacist - Prior Authorization - Mercy Ministry office

Overview:
A Prior Authorization Pharmacist specializes in managing the medication pre-approval process, ensuring prescribed drugs meet clinical guidelines and are covered by insurance.

Key Responsibilities

• Review and Process Requests: Evaluate prior authorization requests for medical necessity, safety, and cost-effectiveness in alignment with clinical guidelines and insurance policies.
• Liaison Role: Serve as a vital link between healthcare providers, patients, and insurance companies to facilitate timely access to medications.
• Documentation and Compliance: Maintain accurate records of prior approvals and ensure compliance with insurance requirements. Assist with initiating new requests and follow up on their status.
• Clinical Support: Provide guidance on medication therapy management and address questions related to new medications.
• Education and Training: Educate healthcare providers and patients on the prior authorization process and promote medication adherence.

Education

• Required:
  • Bachelor of Science (BS) or Doctor of Pharmacy (PharmD) degree from a School or College of Pharmacy accredited by the Accreditation Council for Pharmacy Education (ACPE).

Licensure

• Required:
  • Current pharmacist license from the applicable State Board of Pharmacy.

Experience

• Previous retail experience is preferred but not required.

Other Requirements

• Strong communication and organizational skills.
• Ability to interpret clinical guidelines and insurance policies.

Preferred Experience

• Prior experience in managed care or prior authorization processes.