Prior Authorizations Pharmacist – Full-Time

Job not on LinkedIn

🔥 0 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

⏰ Full Time

🟢 Junior

💊 Pharmacist

👻 Ghost score 12%

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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The OccuNet Company

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1998

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

The OccuNet Company is a privately owned healthcare services firm focused on improving healthcare affordability and member experience through integrated, transparent solutions. It offers services including out-of-network negotiation, reference-based pricing, bill review, medical contract negotiations, and pharmacy benefit management, supported by its OnPoint technology platform and member advocacy teams. The company serves employers, payers, TPAs, health plans, brokers, and providers, emphasizing cost-efficiency, compassionate member support, and tech-enabled administration.

📋 Description

• Review and evaluate pharmacy prior authorization requests according to benefit plans, clinical guidelines, client policies, and regulations • Complete prior authorization reviews within established turnaround times • Apply evidence-based criteria to determine medical necessity and appropriateness of drug therapies • Identify therapeutic optimization and cost-effective medication management opportunities • Recommend formulary alternatives to prescribing providers • Coordinate clinical reviews of pharmacy benefit appeals • Communicate coverage decisions and clinical rationale to providers, members, pharmacy staff, and stakeholders • Conduct provider and member calls for clinical information and consultation • Support development, implementation, and maintenance of prior authorization criteria, clinical guidelines, and utilization management programs • Support formulary management initiatives including step therapy, quantity management, and drug utilization programs • Analyze clinical literature, pharmacy utilization data, prescribing trends, and utilization patterns • Generate and interpret prior authorization reports; present findings and recommendations • Monitor KPIs and improve clinical and operational performance • Improve prior authorization workflows and drug utilization management processes • Provide clinical leadership, mentorship, onboarding, education, and training to clinical staff • Participate in quality assurance, audits, accreditation initiatives, and process improvement projects • Maintain accurate documentation and perform assigned special projects • Ensure compliance with HIPAA, NCQA, URAC, client requirements, and federal and state regulations

🎯 Requirements

• Bachelor of Science in Pharmacy (BSPharm) or Doctor of Pharmacy (Pharm.D.) degree from an accredited college of pharmacy • Active, current, and unrestricted Pharmacist license • Licensure in additional states may be required based on business needs • Minimum of one (1) year of direct prior authorization or utilization management experience • Experience applying evidence-based clinical guidelines in pharmacy practice • Strong clinical knowledge of pharmacotherapy and evidence-based medicine • Knowledge of pharmacy benefit management operations and utilization management principles • Working knowledge of the Medi-Span drug database, including GPI drug classification • Proficiency with Microsoft Excel, Microsoft Word, and pharmacy management systems • Excellent clinical judgment and critical thinking skills • Strong written and verbal communication skills • Strong interpersonal and customer service skills • Strong organizational skills and ability to prioritize competing responsibilities while meeting deadlines • Ability to work independently and collaboratively within a multidisciplinary team

🏖️ Benefits

• 401(k) with matching • Dental insurance • Health insurance • Vision insurance • Health savings account • Paid time off • High-growth environment with clear opportunities for career growth • Welcoming atmosphere and culture • Outward mindset culture emphasizing empathy, mutual respect, and team/client support