Clinical Pharmacist Prior Authorization

Our promise to you:Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.All the benefits and perks you need for you and your family: Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance Paid Time Off from Day One 403-B Retirement Plan 4 Weeks 100% Paid Parental Leave Career Development Whole Person Well-being Resources Mental Health Resources and Support Pet Benefits Schedule:Full timeShift:Day (United States of America)Address:6061 S WILLOW DRCity:GREENWOOD VILLAGEState:ColoradoPostal Code:80111Job Description:Other duties as assigned. Understands and articulates benefit determination details to providers and members. Reviews, interprets, and responds to data provided by providers regarding clinical utilization management edits. Consults with providers’ offices regarding the use of medications and appropriate formulary alternatives. Works with providers’ offices to gather missing complex clinical information as needed. Reviews prior authorization cases and renders coverage determinations based on clinical criteria and prescription plan design. Administers criteria and conditions under which certain drugs, drug classes, or categories require clinical review based on specific guidelines. Initiates, reviews, and follows up on all clinical utilization management programs and appeals processes, including specialty medications. Triages prescription claims that require review for the Clinical Trend Management Package, including PBM standard point of service Quantity Limit, Age Restriction, Step Therapy, and Prior Authorization clinical edits. Consults various applications including pharmacy dispensing software, PBM database, and EMR to gather complex clinical information.Hours: Mon -Fri (day shift)Knowledge, Skills, and Abilities:• Maintains stable performance under pressure or opposition, handles stress in an acceptable way to others and the organization. [Required]• Self-motivated and detail-oriented with the ability to resolve complex matters and visualize processes to identify core functions across multiple departments. [Required]• Good business acumen and understanding of the business processes of pharmacy operations and pharmacy benefit management services. [Required]• Good decision-making skills, including expert problem-solving skills, problem analysis, and discernment under pressure. [Required]• Effective oral and written communication skills, with the ability to articulate complex information in understandable terms to all levels of staff. [Required]• Effective computer skills, particularly Microsoft Office Outlook, Word, Excel, PowerPoint. [Required]• Ability to work in a matrix-management environment to achieve organizational goals. [Required]• Excellent customer service skills: Strong interpersonal skills and the ability to collaborate with internal and external clients. [Required]• Basic financial analysis skills. [Required]• Ability to handle multiple and diverse tasks to meet tight deadlines [Preferred]• Highly entrepreneurial, motivated, and collaborative [Preferred]• Knowledge of retail and specialty pharmacy operations [Preferred]• Knowledge of pharmaceutical and regulatory compliance requirements [Preferred]Education:• Bachelor's [Required]• Doctorate [Preferred]Field of Study:• in PharmacyWork Experience:• 2+ years of experience as a pharmacist in a retail or outpatient pharmacy [Required]• Experience in specialty or retail pharmacy operations with multi-site responsibility [Preferred]• Experience with operating a pharmacy specialty program [Preferred]• Experience with operating a self-insured pharmacy benefit program [Preferred]Additional Information:• N/ALicenses and Certifications:• Licensed Pharmacist (RPh) [Required]Physical Requirements: (Please click the link below to view work requirements)Physical Requirements - Pay Range:$57.26 - $221,512.72This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.Category: PharmacyOrganization: AdventHealth PorterSchedule: Full timeShift: DayReq ID: 151194802

Created: 2026-03-04