Prior Authorization Pharmacist at LSMA Management Inc

San Bernardino, California, United States -

Full Time

Start Date

Immediate

Expiry Date

04 Aug, 26

Salary

0.0

Posted On

06 May, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Pharmacology, Disease State Management, Evidence-Based Medicine, Prior Authorization Review, Utilization Management, Clinical Judgment, Written Communication, Verbal Communication, Organizational Skills, Electronic Medical Records, HIPAA Compliance, Regulatory Compliance

Industry

Health and Human Services

Description

Description JOB SUMMARY: The Prior Authorization Pharmacist is responsible for the clinical review of high-cost, specialty, injectable, and non-formulary medication requests within a healthcare Management Services Organization (MSO). This role ensures that coverage determinations comply with applicable federal and California regulations, evidence-based clinical guidelines, and internal policies. Working collaboratively with Medical Directors, the Pharmacy & Therapeutics (P&T) Committee, and Medical Management leadership, the PA Pharmacist validates adverse determinations, supports utilization management decisions, and serves as a clinical resource for internal and external stakeholders. Requirements MINIMUM & PREFERRED QUALIFICATIONS: Education/Training Minimum: Doctor of Pharmacy (Pharm.D.) from an accredited college or university. Experience Minimum: Demonstrated clinical pharmacy experience with prior authorization review, utilization management, or managed care pharmacy functions. Preferred: Experience reviewing specialty, injectable, or high-cost medications within a managed care, MSO, or health plan environment. Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position. Certification(s) Active, current, and unrestricted Pharmacist License issued by the California State Board of Pharmacy required. Skills, Knowledge & Abilities Advanced knowledge of clinical pharmacology, disease state management, and evidence-based medicine. Strong analytical and critical-thinking skills with the ability to exercise independent clinical judgment. Excellent written and verbal communication skills. Strong organizational skills and ability to manage competing priorities in a deadline-driven environment. Proficiency with electronic medical records, utilization management systems, and standard pharmacy software. Ability to maintain confidentiality and comply with HIPAA and regulatory requirements. PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS: The physical, mental, and environmental demands described below are representative of those required to perform the essential functions of the job, with or without reasonable accommodation. This role is primarily sedentary and requires prolonged periods of sitting, frequent computer use, and repetitive data entry. The employee must be able to read clinical documentation and electronic records, communicate clearly via telephone and written correspondence, and maintain focus and accuracy while reviewing complex clinical information. Occasional travel and driving may be required for trainings or meetings.

Responsibilities

The Prior Authorization Pharmacist performs clinical reviews of high-cost and specialty medication requests to ensure compliance with regulations and clinical guidelines. They collaborate with Medical Directors and the P&T Committee to validate adverse determinations and support utilization management decisions.