Prior Authorization Pharmacist

4 weeks, 1 day ago
Full-time
Mid Level
Operations
Oscar

Oscar

Oscar is a health insurance company that offers plans for individuals, families, and small businesses. With a focus on humanizing health care through technology, design, and data, Oscar provides easy-to-understand bills, 24/7 access to doctors, and a p...

Insurance
1K-5K
Founded 2012

Description

  • Review and render decisions on prior authorizations and appeals for specialty, non-specialty, and physician-administered drugs.
  • Conduct peer-to-peer calls with prescribers to discuss the clinical rationale for adverse determinations.
  • Participate in clinical quality audits and inter-rater reliability testing.
  • Provide internal support for escalations and questions from the team.
  • Apply clinical expertise to support the appropriate and safe use of pharmaceuticals by members and providers.
  • Ensure compliance with all applicable laws and regulations.
  • Perform other duties as assigned.

Requirements

  • 3+ years of experience as a licensed pharmacist.
  • 2+ years of experience performing prior authorization review in a managed care setting.
  • Active, unrestricted pharmacist license.
  • Doctor of Pharmacy (PharmD) degree.
  • Willingness to obtain licensure and training in new states as needed.
  • Clinical experience applying clinical criteria in a clinical review setting (preferred).
  • Board certification such as BCPS or BCOP (preferred).
  • Residency training (preferred).
  • Experience practicing pharmacy in a clinical setting such as retail, hospital, or specialty pharmacy (preferred).

Benefits

  • Base salary of $111,780 to $146,711.25 per year.
  • Eligible for Oscar’s unlimited vacation program.
  • Eligible for annual performance bonuses.
  • Medical, dental, and vision insurance.
  • 11 paid holidays.
  • Paid sick time and paid parental leave.
  • 401(k) plan participation, life insurance, and disability insurance.
  • Paid wellness time and reimbursements.

Interested in this position?

Apply directly on the company website

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