Prior Authorization Pharmacist - Connecticut Medicaid (Remote)

Summary

The Prior Authorization (PA) Pharmacist is responsible for reviewing prior authorization requests from providers to ensure safe and effective medication utilization. The PA pharmacist will work with internal and external stakeholders in evaluating and continually developing a strategy for Utilization Management.

Essential Job Functions

• Review Prior Authorization requests from medical professionals to ensure compliance with the Preferred Drug List (PDL) and current clinical guidelines.

• Support peer-to-peer discussions with medical providers regarding Prior Authorization reviews.

• Collaborate on consultation scripting, incorporating feedback from providers to refine and improve communications.

• Contribute to the success of the Clinical Call Centers and Prior Authorization department by assisting with the development and management of written and verbal communications to members and physicians; serve as a resource for pharmacy-related questions and issues across the organization.

• Drive program improvements through continuous quality improvement processes, proactively identifying opportunities, and collaborating with product leaders to enhance services.

• Maintain clinical integrity of pharmaceutical solutions by staying current on medication information and clinical guidelines; support the identification of best practices and collaborate with Medical Directors and Clinical Pharmacists to provide pharmacy expertise.

• Collaborate with the pharmacy team (Pharmacy Manager, PDL Coordinator, Clinical Pharmacists) to identify trends and new drugs or therapeutic classes requiring utilization management.

• Contribute innovative solutions to enhance the operational efficiency and effectiveness of the pharmacy team.

Requirements

• PharmD or B.S. in Pharmacy with relevant specialty background

• Registered Pharmacist with unrestricted state licensure (Connecticut Pharmacist license preferred but not required)

• Minimum of 4 years of experience in clinical pharmacy

• Strong verbal and written communication skills

• Proficiency with Microsoft Office products and ability to quickly learn proprietary systems

• Expected working hours: 9:00 AM to 5:00 PM Eastern Time, including select holidays and occasional weekend on-call coverage

Basic Qualifications

• Experience coordinating and collaborating with work teams preferred

• Ability to perform clinical reviews using relevant compendia and clinical trial data

• Managed care and/or prior authorization experience a plus

• Strong research skills with the ability to implement findings in practical settings

• Analytical skills that translate into pragmatic, actionable recommendations

• Team-oriented mindset with respect for all members

• Strong interpersonal skills to support successful consultation and collaboration with internal and external stakeholders outside of direct reporting lines

• Prior call center experience preferred

Work Environment

• Remote, work-from-home position (must be based in the United States).

• Must have a private, dedicated workspace with reliable high-speed internet, free from distractions and compliant with HIPAA requirements.

Applications for this posting will be accepted until October 31,2025.

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