Duration: 6 contracts
Position Summary
We are seeking an experienced Prior Authorization Pharmacist to review and evaluate medication prior authorization requests to ensure safe, appropriate, and cost-effective therapy in accordance with clinical guidelines, regulatory requirements, and organizational policies.
This role requires strong clinical decision-making skills, experience applying evidence-based guidelines, and the ability to work efficiently in a high-volume production environment while maintaining quality and accuracy.
Key Responsibilities
- Review and evaluate medication prior authorization requests for:
- Medical necessity
- Clinical appropriateness
- Formulary compliance
- Apply evidence-based clinical guidelines, FDA labeling, drug compendia, and plan-specific criteria to authorization decisions
- Evaluate patient-specific factors including:
- Diagnosis
- Lab results
- Prior therapies
- Dosing
- Contraindications
- Comorbid conditions
- Approve, modify, or deny medication requests and document clinical rationale accurately
- Collaborate with pharmacists, pharmacy technicians, nurses, medical directors, and other clinical teams to resolve complex cases
- Support peer-to-peer reviews and prepare clinical summaries for escalated cases
- Ensure compliance with state and federal regulations, accreditation standards, and internal quality requirements
- Maintain productivity, turnaround time, and quality benchmarks
- Document activities accurately in pharmacy and prior authorization systems
Required Qualifications
- Active and unrestricted Pharmacist license in good standing in AZ or TX
- Bachelor’s Degree in Pharmacy or PharmD required
- Minimum 2+ years of pharmacist experience (3+ years preferred)
- Experience with clinical decision-making using evidence-based guidelines
- Experience working with:
- Formularies
- Preferred drug lists (PDL)
- Medication utilization review
- Ability to work in a high-production team environment
- Strong documentation and communication skills
Preferred Experience
- Prior Authorization experience
- Managed Care or PBM experience
- Medicaid or Commercial insurance pharmacy experience
- Utilization Management experience
- Knowledge of formulary design and prescription benefit trends
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit
www.ustechsolutions.com .
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
AI Statement: By applying, you acknowledge that AI-assisted tools may be used during hiring.
