Job Title:
Clinical Pharmacist
Job Description
The Clinical Pharmacist evaluates prior authorization and appeal requests by reviewing clinical documentation and making coverage determinations based on established criteria. This role focuses on clinical evaluation rather than dispensing and involves close collaboration with prescribers, pharmacies, and internal teams to gather necessary information, document decisions, and communicate outcomes. The pharmacist ensures all reviews are accurate, timely, and compliant with applicable regulatory and client requirements, and actively contributes to process and workflow improvements in the prior authorization program, making a meaningful impact on patient care.
Responsibilities

+ Review prior authorization and appeal requests by evaluating clinical documentation and applying established clinical and coverage criteria.

+ Make clear, defensible coverage determinations and document medical necessity decisions in a th...