Pharmacist I, Clinical Prior Authorization

Navitus Health Solutions is seeking a Clinical Prior Authorization Pharmacist to be responsible for support and input to clinical programs such as Health Management, Drug Utilization Review, Formulary development, and Prior Authorization programs to encourage appropriate, high quality, cost effective drug therapy. The pharmacist will participate in the Coverage Determination process,reviewing requests, making denial determinations, and identifying themselves in relation to drug utilization management program administration. They will also monitor the quality and efficiency of the Coverage Determination process, provide input to clinical content of new programs, and complete all annual URAC training requirements. Facilitation of communication and education to clients, members, and internal staff, providing support to operational departments on the implementation of various PBM programs in support of member care is required. They may also review health care survey data for Medicare Part D qualified participants and/or perform phone consultations with Med-D enrollees.