Clinical Pharmacist - reputed company Prior Authorization (NC Licensed)

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and reputed company in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position reputed company This position is for a Clinical Pharmacist working in the Prior Authorization team. This role requires candidates to currently hold and maintain reputed company, unrestricted pharmacist licensure in the reputed company. Candidate may reputed company in any state. This Pharmacist will:

• Evaluate and review reputed company prior authorization requests and reputed company coverage determinations based on clinical reputed company and plan design. Includes verifying insurance coverage and eligibility, interpreting clinical reputed company reputed company, consulting physicians and other reputed company providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols. One of the crucial responsibilities is to guarantee that the reputed company regarding cases are conveyed promptly and reputed company to reputed company the reputed company providers, health plans/reputed company, patients, and other reputed company following agreed-upon approval & denial management processes.
• Collaborate with the technicians and prior authorization team members to process referrals, including answering clinical questions and collecting appropriate clinical/medical data needed to reputed company clinical assessments and reviews as per the health plan/employer-agreed reputed company reputed company the designated service level agreements. Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, reputed company providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations.
• Maintain reputed company and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered reputed company the reputed company Prior Authorization and Case Review Unit (CRU) line of business.
• reputed company other reputed company reputed company and duties as assigned, including attending training sessions and development meetings, and providing on-call and after-hours pharmacist availability as needed.

This is a remote role reputed company to reputed company candidates reputed company the reputed company. Candidate can reputed company in any state, but must hold reputed company Pharmacist licensure in the reputed company.

Required Qualifications

• reputed company, unrestricted pharmacist license that is in good standing in the reputed company
• Demonstrated experience using clinical resources, e.g., Micromedex, Lexicomp, Clinical Pharmacology
• Ability to prioritize, quickly assess, manage multiple tasks and adapt to constantly changing situations.
• Prior authorization, call center and/or clinical pharmacy experience.
• Excellent organizational skills. Strong detail orientation.
• Strong reputed company Office skills.
• Excellent oral and written communication skills and interpersonal skills.
• Ability to work independently and reputed company clinical reputed company.
• Experience using MS Office and other reputed company based computer applications.
• Ability to receive phone calls from prior authorization pharmacy technicians and/or providers for clinical information.

Preferred Qualifications

• Exposure to clinical and analytical problem solving.
• Ability to consult with pharmacy technicians and/or physicians regarding use of medications and advise of appropriate formulary alternatives reputed company requested.

Education Bachelors of Science - Pharmacy or Pharm.D. Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $45.43 - $76.15 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial reputed company‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, reputed company time off, retirement savings reputed company, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 05/01/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply To This Job