Clinical Pharmacist, Prior Authorizations

Who We Are:

EmpiRx Health is a disruptor in an ever-changing healthcare industry, offering a market-differentiating, value-based pharmacy benefits management solution.  We are bold and fearless in our approach to healthcare, how we talk about ourselves, and our use of advanced technology and analytics.

What We Do:

We partner with HR and Benefits managers nationwide to ensure our membership has access to the best pharmacy benefits available.  We place more emphasis on member care than any other PBM by focusing on health outcomes first.  Our pharmacists and clinicians are at the center of everything we do―and our population health solution delivers tailored strategies for our clients.  Our pharmaceutical staff daily consults with physicians to drive the greatest clinical and financial outcomes.

Employee-Centric Culture:

At EmpiRx Health, our employees are our most valuable asset.  We've earned recognition as an award-winning leader in healthcare by investing in our employees. We are committed to fostering a culture of excellence and continuous improvement. Our approach to performance management is designed to empower employees to achieve their full potential while contributing to the overall success of the organization. Our leadership teams drive the employee experience with a strength-based learning and development approach. We've fostered an environment where every voice is heard, and talents are nurtured. At EmpiRx Health, we celebrate groundbreaking ideas, encourage collaboration, and value open dialogue.

Who We're Looking For:

EmpiRx Health is in unprecedented growth, and we're seeking a highly skilled and experienced Clinical Pharmacist – Prior Authorization.  In this critical role, you will ensure clinical prior authorization and appeal determinations in accordance with covered plan design while ensuring clinically appropriate pharmacy care and the deep and sustainable clinical savings to our clients. 

If you are a highly motivated Clinical Pharmacist - Prior Authorization with a strong background in comprehensive case review and direct physician engagement, and you are passionate about making a meaningful impact in the healthcare industry, we encourage you to apply.

What You'll Do:

As a Clinical Pharmacist – Prior Authorization, your role will encompass a wide range of responsibilities:

• Act as a clinical expert on prior authorization review and evaluation in accordance with clinical criteria and covered plan design.  
• Review, evaluate and resolve all assigned clinical reviews through comprehensive case review and highlight our Population Health Management model with direct physician engagement.
• Subject matter expert on the EmpiRx Health Population Health Management Model
• Review and evaluate clinical literature resources to support decision-making and recommendation to providers. 
• Monitor and proactively identify clinical interventions to ensure clinical savings guarantees are met. 
• Perform peer-to-peer reviews with providers on identified cases or when requested. 
• Provide guidance and support to members, providers, and other healthcare providers on clinical related inquiries.
• Collaborate with clinical technicians, prior authorization team members to facilitate clinical review requests, answer questions and/or resolve escalations.  
•  Convey clinical determinations promptly within established turnaround time requirements to prescribers, members and other healthcare professionals following agreed-upon approval, denial processes. 
• Participate in continuous quality improvement efforts to streamline the clinical review process and enhance member care.  
• Stay updated with changes in pharmacy practice, and industry regulations through continuing education and professional development.  
• Stay informed about EmpiRx Health formulary changes, clinical programs, and internal policies. 
• Act as a clinical resource for internal staff and support staff training/development as required.  
• Proficiently utilize pharmacy management software for documentation and communications  
• Proficiently utilize Microsoft Office tools  
• Utilize external clinical and drug information tools to support clinical reviews and decision making as well as to stay abreast of current drug pipeline (e.g., IPD, Policy Reporter, UpToDate and MediSpan) 
• Collaborate with internal clinical team and cross functional teams to provide clinical support and guidance, as needed, includes but not limited to claim/data review, clinical interventions, and provider/member/client support as required. 

What You Need:

• 3+ years pharmacy experience
• PharmD (required) 
• Active pharmacist license
• Exceptional written and verbal communication skills
• Experienced in Microsoft Office Suite; prescription medication analysis.

Preferred:

• PBM/Health Plan experience evaluating and reviewing Prior Authorization
• Specialty Pharmacy experience
• MTM certification, or other specialty certifications

Benefits and Perks:

At EmpiRx Health, we understand that a fulfilling career goes beyond the tasks at hand. It's about creating an environment where employees thrive both professionally and personally. As a valued member of our team, you'll have access to a range of benefits designed to support your overall wellbeing and enhance your work-life balance:

• Medical, prescription, vision, dental, life, and disability insurance, with coverage for domestic partnerships.
• A 401K match program to secure your financial future.
• Parental leave for childbirth and adoption.
• Student loan reimbursement.
• Additional perks include flexible PTO, hybrid work arrangements, online wellness resources and counseling access, and an employee discount program.

Join EmpiRx Health, where we are transforming the healthcare landscape with innovation and unwavering commitment to our employees and members.  Make a difference and grow with us!

Work Environment: Hybrid in Montvale, NJ.  We will consider remote for the right candidate.

EmpiRx Health is an Equal Opportunity Employer 

At EmpiRx Health, we wholeheartedly embrace the power of diversity and the magic of inclusion.  The kaleidoscope of unique perspectives, backgrounds, and talents fuels our innovation and sets us apart.  We're on a mission to build a team as diverse as the world we serve, where everyone is welcome and celebrated.  We're not just breaking down barriers; we're actively erasing them to create an environment where opportunity knows no bounds.  In unity, we find our strength and invite individuals from all walks of life to join us in our exhilarating journey to shape a brighter, more inclusive future together.

Compensation Structure

The compensation structure for this position at our company is governed by various state Fair Pay Acts. Salaries will vary based on multiple factors, including but not limited to professional and academic experience, training, associated responsibilities, and other business and organizational needs.

Powered by JazzHR

Pk0nSCrqUC