Pharmacist (R)

Title: Prior Authorization Pharmacist (R)Location: Remote – EST
Contract Length: 13 Weeks (Possible Extension)
Shift: EST / (8hrs.*5 days) Business HoursJob Summary:We are seeking a licensed Pharmacist to join our Prior Authorization Department. The Pharmacist will review prior authorization requests, make coverage and medical-necessity determinations, and ensure decisions align with clinical guidelines, regulations, and established criteria.Job Duties:

• Review and process prior authorization requests for pharmaceutical products.
• Make medical necessities and benefit determinations using established criteria and pharmacy guidelines.
• Provide clinical support to the Perform Rx Customer Care Center.
• Communicate with providers to obtain information and support appropriate determinations.
• Support Fraud and Abuse program oversight and related clinical activities.
• Stay current with industry trends, regulatory changes, operational directives, and customer-specific reference materials.

• Active Pharmacist license
• PharmD or equivalent pharmacy qualification.
• Recent 1 year of Prior Authorization or Coverage Determination experience is required.
• Flexibility to work a rotating weekend schedule if required by business needs.