Pharmacist-Health Plan
Job ID #1996834
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About this Role
Perform Prior Authorizations; perform duties related to Drug Utilization Review including concurrent, retrospective, and prospective components; and support Customer Care with clinical calls requiring pharmacist intervention
Job details
$53.00 / hour
Remote, Texas
Profession: Pharmacist
Facility Type: ???
Specialty: Health Plan
Division:
MedFi
Start Date: 02/23/2026
Responsibilities
Responsible for support and input to clinical programs such as: Health Management, Drug Utilization
Continually monitor the quality and efficiency of the Coverage Determination process including coverage criteria, denial language, and communication with prescribers.
Participate in Coverage Determination process
Provide input to clinical content of new programs and for maintenance of existing programs.
Complete all annual URAC training requirements
Responsible for participating in core teams working on new program/ product development.
Facilitation of communication and education to clients, members, and internal staff regarding clinical daily issues and objectives.
Provide support to operational departments on the implementation of various PBM programs and daily functioning in support of member/patient quality of care.
Responsible for supporting / providing clinical expertise related to formulary decisions made by the
Required Qualifications
TX or NC Pharmacist license
2+ years of previous experience working with processing Proir Authorizations
Must have strong computer skills and able to troubleshoot basic computer skills independently