Clinical Pharmacist - Prior Authorization at LanceSoft, Inc.

Position Summary: - The Prior Authorization Pharmacist is responsible for reviewing and evaluating medication prior authorization requests to ensure appropriate, safe, and cost-effective therapy in accordance with clinical guidelines, regulatory requirements, and organizational policies. - This role applies clinical judgement to support optimal patient outcomes while balancing utilization management objectives. Duties: - Review, assess, and adjudicate medication prior authorization requests for medical necessity, clinical appropriateness, and formulary compliance. - Apply evidence-based clinical guidelines, drug compendia, FDA labeling, and plan-specific criteria to authorization decisions. - Evaluate patient-specific factors including diagnosis, laboratory results, prior therapy, dosing, contraindications, and comorbid conditions. - Authorize, modify, or deny medication requests. - Document clinical rationale clearly and accurately. - Collaborate with pharmacy technicians, nurses, medical directors, and other clinical staff to resolve complex cases. - Support peer-to-peer reviews and prepare clinical summaries when escalation is required. - Ensure compliance with state and federal regulations, accreditation standards (e.g., NCQA, URAC), and internal audit requirements. - Maintain productivity, turnaround time, and quality benchmarks for prior authorization processing. - Document all activities accurately within prior authorization and pharmacy management systems. Experience and Requirements: - Active and unrestricted AZ or TX pharmacist license in good standing. - 3+ years of experience working as a pharmacist. - Experience with clinical decision-making while applying evidence-based clinical guidelines or criteria. - Experience utilizing formularies or preferred drug lists. - Experience working in a high production team environment. - Knowledge of clinical program components, formulary designs, and prescription benefit trends. Education: - High School Diploma or GED. - Bachelor's degree in Pharmacy or PharmD. - At least two years of experience as a pharmacist.

Clinical Pharmacist - Prior Authorization

Emma

Responsibilities

Skills wanted:

Formal education:

Language(s) required:

Rajendra Singh Solanki

About LanceSoft, Inc.:

mission:

www.lancesoft.com/jobs

Admin access needed