*Clinical Pharmacist - Prior Authorization
LanceSoft Inc
- Please note: Actual location may vary., RI
- 3 days ago
- Remote
Highlights
Position Summary: The Prior Authorization Pharmacist is responsible for reviewing and evaluating medication prior authorization requests to ensure appropriate, safe, and cost-effective therapy in accordance with clinical guidelines, regulatory requirements, and organizational policies. Evaluate patient-specific factors including diagnosis, laboratory results, prior therapy, dosing, contraindications, and comorbid conditions.
Numbers & Facts
| Location | Please note: Actual location may vary., RI (Remote) |
| Industry | Staffing/Employment Agencies |
| Salary | $63–$65.75 Per Hour |
| Company Size | 2,000 to 2,499 employees |
| Year Founded | 2000 |
| Website | http://www.lancesoft.com/ |
Description
Job ID: 26-149800
Position Type: Temporary
Location: Remote
Work Type: Fulltime
Est. Pay Range: $63.00/hr. to $65.75/hr. all-inclusive on W2
Position Summary:
Duties:
Experience:
Education:
Employee Benefits:
At LanceSoft, full time regular employees who work a minimum of 30 hours a week or more are entitled to the following benefits:
Four options of medical Insurance
Dental and Vision Insurance
401k Contributions
Critical Illness Insurance
Voluntary Permanent Life Insurance
Accident Insurance
Other Employee Perks
LanceSoft is a certified Minority Business Enterprise (MBE) and an equal opportunity employer. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. LanceSoft makes hiring decisions based solely on qualifications, merit, and business needs at the time.
Position Type: Temporary
Location: Remote
Work Type: Fulltime
Est. Pay Range: $63.00/hr. to $65.75/hr. all-inclusive on W2
Position Summary:
- The Prior Authorization Pharmacist is responsible for reviewing and evaluating medication prior authorization requests to ensure appropriate, safe, and cost-effective therapy in accordance with clinical guidelines, regulatory requirements, and organizational policies.
- This role applies clinical judgement to support optimal patient outcomes while balancing utilization management objectives.
Duties:
- Review, assess, adjudicate medication prior authorization requests for medical necessity, clinical appropriateness, and formulary compliance.
- Apply evidence-based clinical guidelines, drug compendia, FDA labeling, and plan-specific criteria to authorization decisions.
- Evaluate patient-specific factors including diagnosis, laboratory results, prior therapy, dosing, contraindications, and comorbid conditions.
- Authorize, modify, or deny medication requests and document clinical rationale clearly and accurately.
- Collaborate with pharmacy technicians, nurses, medical directors, and other clinical staff to resolve complex cases.
- Support peer-to-peer reviews and prepare clinical summaries when escalation is required.
- Ensure compliance with state and federal regulations, accreditation standards (e.g. NCQA, URAC), and internal audit requirements.
- Maintain productivity, turnaround time, and quality benchmarks for prior authorization processing.
- Document all activities accurately within prior authorization and pharmacy management systems.
Experience:
- Active and unrestricted AZ or TX pharmacist license.
- Experience with clinical decision-making while applying evidence based clinical guidelines/criteria; utilizing formularies/preferred drug lists.
- Experience working in a high production team environment.
- 3+ years experience working as a pharmacist.
- Knowledge of clinical program components, formulary designs, and prescription benefit trends.
Education:
- Bachelor's degree in pharmacy or Pharm D. also required with at least two years experience as a pharmacist.
- Must have an active license in good standing.
Employee Benefits:
At LanceSoft, full time regular employees who work a minimum of 30 hours a week or more are entitled to the following benefits:
Four options of medical Insurance
Dental and Vision Insurance
401k Contributions
Critical Illness Insurance
Voluntary Permanent Life Insurance
Accident Insurance
Other Employee Perks
LanceSoft is a certified Minority Business Enterprise (MBE) and an equal opportunity employer. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. LanceSoft makes hiring decisions based solely on qualifications, merit, and business needs at the time.
About Company
We are a $125 Million, NMSDC-certified Minority & Woman owned Workforce Solutions Company headquartered in the DC metro area with presence across US with global presence - Canada, Mexico, India, UK, Malaysia, Indonasia, Hongkong, Singapore, UAE. We are specialized in providing Workforce Solutions, SOW project delivery, Engineering Solutions, Creative Services. We currently support 100+ Fortune companies globally and across multiple industry segments. We are currently supporting several massive programs across industry segment nationally/globally (Intel, Ally, AMD, QUALCOMM, Morgan Stanley, Kraft/ Mondelez, MNP, Amdocs, Dell, SanDisk, Medtronic, Becton Dickinson, GE, Lockheed Martin, UTC, L-3 Communications, Caterpillar, BMW, Mercedes Benz, National Grid, Dominion, Energy Future Holdings, PSEG, 3M, Fidelity, Aetna, Humana, Johnson & Johnson, Pfizer, Merck etc).
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender, identity, national origin, disability, or protected veteran status.