Pharmacist I – Clinical Prior Authorization

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🏈 Alabama, Arizona, +33 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote 🧀 Wisconsin – Remote 🍑 Georgia – Remote

💵 $101.3k - $126.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

👻 Ghost score 0%

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Navitus Health Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

💼 Consulting

🛡️ Insurance

🏥 Healthcare

Consulting • Insurance • Healthcare

Navitus Health Solutions is a pharmacy benefit manager (PBM) that provides transparent, people-centered pharmacy benefit solutions to health plans, employers, government programs and other plan sponsors. The company operates a 100% pass-through, cost-plus model that emphasizes lowering medication costs, managing formularies, specialty drug management (including a cost-plus specialty pharmacy), claims adjudication, pharmacy network management, and member enablement and support services. Navitus positions itself as a fiduciary partner focused on affordability, compliance, clinical quality and improving health outcomes through tailored PBM services and digital health integrations.

📋 Description

• Perform Prior Authorizations. • Perform duties related to Drug Utilization Review, including concurrent, retrospective, and prospective components. • Support Customer Care with clinical calls requiring pharmacist intervention. • Interface with physicians, pharmacists, and specialty pharmacy providers regarding beneficiaries’ benefits and therapeutic interventions. • Review and evaluate health surveys and utilization data for program management and development. • Support and provide input to clinical programs such as Health Management, Drug Utilization Review, Formulary development, and Prior Authorization programs. • Participate in the Coverage Determination process by reviewing requests not clearly approvable based on specified criteria, making coverage denial determinations, and identifying themselves in relation to drug utilization management program administration. • Monitor the quality and efficiency of the Coverage Determination process, including coverage criteria, denial language, and communication with prescribers. • Provide input to clinical content of new programs and maintain existing programs. • Complete all annual URAC training requirements. • Facilitate communication and education for clients, members, and internal staff regarding clinical daily issues and objectives. • Support operational departments on implementation and daily functioning of PBM programs in support of member/patient quality of care. • Provide clinical expertise related to formulary decisions made by the Pharmacy and Therapeutics committee. • Review health care survey data for Medicare Part D qualified participants and/or perform phone consultations with Medicare Part D enrollees; aid in call documentation and designate enrollees for repeat interaction. • Perform other duties as assigned.

🎯 Requirements

• A minimum of a bachelor’s degree in Pharmacy or Pharm D. • Current, unrestricted licensure as a Registered Pharmacist in the state of residence, or the ability to gain reciprocity within 4 months, may be required based on state of residence laws or client contracts. • Other State Pharmacy Licenses may be required as business need dictates. • Must continually maintain education credits to maintain active licensure. • Two years’ work experience in a clinical setting, or clinical or managed care pharmacy practice residency preferred. • Knowledge of PBM industry, formulary management, pharmacy claims and managed care principles and practices desired. • Exceptional clinical skills and ability to apply sound clinical judgment to a variety of situations is necessary. • Proficiency in drug literature and clinical trial evaluation, including proficiency with electronic databases (e.g., Micromedex, Medline, Internet) preferred. • Ability to reason and translate clinical information into a manner appropriate for clinical systems and clinical/non-clinical audiences. • Emphasis on problem-solving skills, including identifying and accepting a challenging situation and creating and implementing a solution. • Requires attention to details to assure projects are clinically, editorially, and systems accurate and can be operationalized. • Proficiency in MS Word, Excel, Power Point including tables, charts and figures preferred. • Participate in, adhere to, and support compliance program objectives. • The ability to consistently interact cooperatively and respectfully with other employees.

🏖️ Benefits

• Top of the industry benefits for Health, Dental, and Vision insurance • 20 days paid time off • 4 weeks paid parental leave • 9 paid holidays • 401K company match of up to 5% - No vesting requirement • Adoption Assistance Program • Flexible Spending Account • Educational Assistance Plan and Professional Membership assistance • Referral Bonus Program – up to $750!

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