Prior Authorization Pharmacist

🔥 13 hours ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $110k - $130k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

💊 Pharmacist

👻 Ghost score 0%

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Soleo Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

Soleo Health is a specialty pharmacy company that goes beyond simply filling prescriptions by providing personalized patient experiences and access to specialized medications and infusion therapies. They offer treatment in patients' homes, in providers' offices, or at one of their many nationwide infusion centers. Soleo Health specializes in treating complex and ultra-rare diseases with a focus on improving patient quality of life and optimizing health outcomes. They work closely with patients, providers, pharmaceutical manufacturers, payors, and health systems to deliver high-cost therapies, demonstrating value through real-world outcome data. Soleo Health is recognized for its clinical excellence and dedication to patient care, and offers nationwide services, including an online portal, Soleo Connect®, for real-time communication.

📋 Description

• Perform comprehensive clinical reviews and manage prior authorization requests for specialty pharmacy and infusion therapies • Assess clinical documentation against payer-specific medical necessity criteria, coverage policies, and clinical guidelines • Prepare, submit, and track prior authorization requests to PBMs and health plans • Communicate with PBMs and health plans to clarify clinical information, provide additional documentation, and resolve authorization issues • Mitigate denials by addressing rejections in real time through live outreach to PBMs and payers • Create and submit evidence-based appeal letters with clinical rationale, literature support, and policy alignment • Collaborate with the patient access team and internal stakeholders to obtain documentation and optimize patient access to therapy • Monitor authorization outcomes and track performance metrics to identify delays, barriers, or trends • Stay current with payer policies, clinical guidelines, and regulatory requirements • Identify workflow and training optimization opportunities and contribute to process improvement initiatives

🎯 Requirements

• Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy from an accredited institution • Active, unrestricted U.S. pharmacist license • 2+ years of experience in prior authorization, utilization management, PBM, managed care, or payer pharmacy operations • Strong understanding of drug therapy, clinical guidelines, specialty medications, and formulary management • Excellent analytical, clinical decision-making, and documentation skills • Proficiency in pharmacy benefit systems, prior authorization platforms, and electronic documentation • Strong written and verbal communication skills • Ability to manage multiple priorities and perform in a fast-paced environment with strict timelines • High level of integrity and ability to handle confidential or sensitive clinical information • Multi-state pharmacist licensure preferred • Experience reviewing specialty medications, biologics, or complex therapy classes preferred • Prior PBM or health plan experience preferred • Experience with clinical criteria development, formulary management, or utilization management programs preferred • Familiarity with claims systems, PA automation tools, or pharmacy informatics preferred • Competent in the use of Word, Excel, and PowerPoint • Must be able to communicate effectively with all levels of organization within Soleo Health • Must enthusiastically support Soleo Health’s philosophy and goals

🏖️ Benefits

• Competitive Wages • 401(k) with a Match • Referral Bonus • Paid Time Off • Great Company Culture • Annual Merit Based Increases • No Weekends or Holidays • Paid Parental Leave Options • Affordable Medical, Dental, & Vision Insurance Plans • Company Paid Disability & Basic Life Insurance • HSA & FSA (including dependent care) Options • Education Assistance Program