Prior Authorization Pharmacist

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HealthcarePharmacist

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Quick Summary

Key Responsibilities

Review and render decisions on authorizations and appeals for specialty, non-specialty,

Requirements Summary

3+ years of experience as a licensed pharmacist 2+ years of experience performing prior authorization review in a managed care setting Active,

Technical Tools

HealthcarePharmacist

Hi, we're Oscar. We're hiring a Prior Authorization Pharmacist to join our Pharmacy Team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the Role

~1 min read

This role serves as a reviewer of prior authorizations.

You will report into the Clinical Pharmacist Supervisor.

Responsibilities

~1 min read

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

Requirements

~1 min read

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 Degree
Willingness to obtain licensure/training with new states

Nice to Have

~2 min read

Clinical experience applying clinical criteria in clinical review setting
Board Certification (i.e. BCPS, BCOP)
Residency training
Experience practicing pharmacy in a clinical setting (i.e. retail, hospital, and specialty)

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At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

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