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Pharmacist Operations Advisor

Pharmacist Operations Advisor

Rose InternationalAtlanta, GA, US
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Date Posted : 09 / 03 / 2025

Hiring Organization : Rose International

Position Number : 487989

Industry : Pharmaceutical / Healthcare

Job Title : Pharmacist Operations Advisor

Job Location : Remote, USA

Work Model : Remote

Shift :

Sunday to Thursday or Tuesday to Saturday

10 : 30 AM to 7 : 00 PM CST

Employment Type : Temporary

FT / PT : Full-Time

Estimated Duration (In months) : 7

Min Hourly Rate ($) : 50.00

Max Hourly Rate ($) : 53.00

Must Have Skills / Attributes : Clinical Data management, Microsoft Excel, Microsoft Word, Pharmacy

Experience Desired : Experience with prior authorization (PA) reviews or clinical case review (2+ yrs); Active pharmacist license in the state of practice / residence (1+ yrs)

Required Minimum Education : Bachelor’s Degree

Preferred Education : Ph.D. / Doctorate

Required Certifications / Licenses : Pharmacist license

  • C2C is not available

Job Description

Required Education

  • Bachelor’s Degree – BS Pharmacy
  • Active pharmacist license in the state of practice / residence.

    • Preferred Education

  • Doctorate – PharmD.

    • Required License / Certification

  • Active pharmacist license.

    • Required Qualifications / Skills / Experience

  • Prior experience with prior authorization (PA) reviews or clinical case review in a high-volume or production setting
  • Direct experience processing PA requests, ideally with a commercial or specialty pharmacy
  • Strong documentation of meeting service level agreements (SLAs) or production targets
  • Ability to multitask using multiple technology platforms and clinical resources
  • Proficiency with Microsoft Office (Excel and Word)
  • Experience using multiple clinical and administrative systems simultaneously
  • Effective written and verbal communication skills
  • Ability to collaborate with cross-functional clinical and non-clinical staff
  • Comfort handling phone-based interactions with providers and patients.

    • Preferred Qualifications / Skills / Experience

  • Retail pharmacy experience (not required, but candidates with this background have been successful in the role).

    • Pharmacist / Clinician Overview

  • Operation-based role that conducts criteria-based and clinical review of medical data for prior authorization in alignment with policy and procedure
  • Applies clinical knowledge to plan and approve criteria for case reviews
  • Works within Client-supported systems to handle inbound calls from physicians or members regarding pending, approved, or denied prior authorizations
  • Provides internal support to the Prior Authorization team and the Member Services department
  • Provides on-call, after-hours availability for urgent prior authorization requests as needed
  • Position is remote, available to candidates anywhere in the continental U.S. except New Mexico and Colorado
  • Requires a broadband internet connection and a smartphone

    • Job Duties

  • Evaluate and review prior authorization requests, render coverage determinations based on clinical criteria, and plan design
  • Verify insurance coverage and eligibility, interpret clinical guideline criteria, and consult with healthcare providers
  • Communicate approval and denial decisions promptly to providers, employers, patients, and other stakeholders
  • Collaborate with technicians and team members to process referrals, answer clinical questions, and collect required data
  • Handle inbound / outbound calls to facilitate requests, answer inquiries, and resolve escalations
  • Maintain professional and technical knowledge of drug and disease states for specialty and non-specialty programs
  • Attend training sessions, development meetings, and provide after-hours / on-call support as required
  • Perform other related duties as assigned.

    • Essential Functions

  • Regular and predictable attendance
  • Ability to work mandatory overtime or extended work weeks as needed
  • Compliance with departmental, company, state, and federal requirements
  • Adherence to policies and procedures
  • Ongoing participation in training and development meetings.
  • Only those lawfully authorized to work in the designated country associated with the position will be considered.
  • Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.

    • Benefits :

    For information and details on employment benefits offered with this position, please visit here. Should you have any questions / concerns, please contact our HR Department via our secure website.

    California Pay Equity :

    For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations' website here.

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