Pharmacist I – Clinical Prior Authorization

Navitus Health Solutions

. Perform Prior Authorizations.

Posted 11/5/2026full-timeRemote • United StatesMid-LevelSenior💰 $101,335 - $126,669 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Prior Authorization processes, Drug Utilization Review, and formulary management while maintaining active pharmacist licensure. Proficient in clinical judgment, problem-solving, and effective communication with healthcare professionals and patients.

Highest-signal resume keywords

Registered Pharmacist LicensurePrior Authorization ExperienceDrug Utilization ReviewClinical SkillsPBM Industry Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical JudgmentFormulary ManagementDrug Literature EvaluationClinical Trial EvaluationPharmacy Claims Processing

Soft Skills

Problem-Solving SkillsAttention to DetailCooperative Interaction

Tools & Technologies

MicromedexMedlineMS WordMS ExcelMS PowerPoint

Certifications & Qualifications

Bachelor’s Degree in PharmacyPharm DContinuing Education Credits

Industry Keywords

Managed Care PharmacyCoverage DeterminationHealth ManagementClinical ProgramsMedicare Part D

About the role

Key responsibilities & impact

Perform Prior Authorizations.
Perform duties related to Drug Utilization Review, including concurrent, retrospective, and prospective components.
Support Customer Care with clinical calls requiring pharmacist intervention.
Interface with physicians, pharmacists, and specialty pharmacy providers regarding beneficiaries’ benefits and therapeutic interventions.
Review and evaluate health surveys and utilization data for program management and development.
Support and provide input to clinical programs such as Health Management, Drug Utilization Review, Formulary development, and Prior Authorization programs.
Participate in the Coverage Determination process by reviewing requests not clearly approvable based on specified criteria, making coverage denial determinations, and identifying themselves in relation to drug utilization management program administration.
Monitor the quality and efficiency of the Coverage Determination process, including coverage criteria, denial language, and communication with prescribers.
Provide input to clinical content of new programs and maintain existing programs.
Complete all annual URAC training requirements.
Facilitate communication and education for clients, members, and internal staff regarding clinical daily issues and objectives.
Support operational departments on implementation and daily functioning of PBM programs in support of member/patient quality of care.
Provide clinical expertise related to formulary decisions made by the Pharmacy and Therapeutics committee.
Review health care survey data for Medicare Part D qualified participants and/or perform phone consultations with Medicare Part D enrollees; aid in call documentation and designate enrollees for repeat interaction.
Perform other duties as assigned.

Requirements

What you’ll need

A minimum of a bachelor’s degree in Pharmacy or Pharm D.
Current, unrestricted licensure as a Registered Pharmacist in the state of residence, or the ability to gain reciprocity within 4 months, may be required based on state of residence laws or client contracts.
Other State Pharmacy Licenses may be required as business need dictates.
Must continually maintain education credits to maintain active licensure.
Two years’ work experience in a clinical setting, or clinical or managed care pharmacy practice residency preferred.
Knowledge of PBM industry, formulary management, pharmacy claims and managed care principles and practices desired.
Exceptional clinical skills and ability to apply sound clinical judgment to a variety of situations is necessary.
Proficiency in drug literature and clinical trial evaluation, including proficiency with electronic databases (e.g., Micromedex, Medline, Internet) preferred.
Ability to reason and translate clinical information into a manner appropriate for clinical systems and clinical/non-clinical audiences.
Emphasis on problem-solving skills, including identifying and accepting a challenging situation and creating and implementing a solution.
Requires attention to details to assure projects are clinically, editorially, and systems accurate and can be operationalized.
Proficiency in MS Word, Excel, Power Point including tables, charts and figures preferred.
Participate in, adhere to, and support compliance program objectives.
The ability to consistently interact cooperatively and respectfully with other employees.

Benefits

Comp & perks

Top of the industry benefits for Health, Dental, and Vision insurance
20 days paid time off
4 weeks paid parental leave
9 paid holidays
401K company match of up to 5% - No vesting requirement
Adoption Assistance Program
Flexible Spending Account
Educational Assistance Plan and Professional Membership assistance
Referral Bonus Program – up to $750!