Prior Authorization Pharmacist

🔥 12 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Medical Review Institute of America, LLC

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1983

🛡️ Insurance

💼 Consulting

⚖️ Legal

Insurance • Consulting • Legal

Medical Review Institute of America, LLC is a company specializing in clinical and utilization review services. They offer a comprehensive suite of data-driven solutions, including prior authorization optimization, second opinions, and specialty drug reviews, aimed at ensuring the right care is delivered at the right time and in the right place. MRIoA provides services to health plans, pharmacy benefit managers, government entities, and self-insured employers, among others. They leverage technology and a network of professionals to streamline clinical decisions, enhance provider performance, and ensure compliance with regulatory requirements across all 50 states. Their tools and platforms are designed to optimize clinical reviews, reduce costs, and improve patient outcomes through evidence-based care pathways and telehealth solutions.

📋 Description

• Evaluate prior authorizations for drug appropriateness according to drug policy criteria • Provide cost-effective, rational drug therapy and disease state management • Provide customer service to health plan clients, practitioners, and members • Serve as an educational resource regarding drug and clinical information for internal and external customers • Perform case reviews for prior authorizations • Complete peer-to-peer reviews with healthcare professionals regarding prior authorization outcomes • Serve as an active member of client committees as requested • Monitor prescription turnaround time to meet internal standards and client performance guarantees • Serve as a resource for team members for clinical and drug information • Assist with programs and process improvements to enhance customer service • Provide high-quality medication reviews with clear determination notes • Communicate issues or concerns proactively to the team and Supervisor, PA Pharmacist • Recognize and recommend operational improvements • Complete other special projects and assigned tasks

🎯 Requirements

• Possess a strong drug knowledge and be able to clinically evaluate all drug authorization requests correctly • Ability to work in a fast-paced and high-functioning environment and meet deadlines while managing multiple high priorities • Personal computer literacy and high competency in Microsoft Word and Excel • Strong organizational skills with attention to details • Strong oral and written communication skills • Well-developed training skills • Strong working knowledge of medical insurance terminology and processes • Excellent critical thinking capabilities with a strong attention to detail • Exceptional customer service skills • Minimum two years of experience as a pharmacist preferred • Pharmacy Benefit Management experience preferred • Credentialed and privileged by the company's credentialing committee • Willingness to obtain additional state licensure as required for the position • PharmD • Pharmacist license in good standing • Ability to sit at a desk and utilize a computer, telephone, and other basic office equipment • Must pass a background screen before beginning employment • Must take a drug screen and agree to necessary compliance regulations on the first day of employment • Must adhere to applicable HIPAA regulations and company confidentiality, privacy, and security policies

🏖️ Benefits

• A competitive compensation package • Healthcare, vision and dental insurance • Generous 401k match • Paid vacation, personal time, and holidays • Growth and training opportunities • An award-winning remote work environment