Job Type

Full-time

Description

The Clinical Pharmacist - PA Hub Configuration and Reviewer plays a key role in ensuring that clinical criteria are accurately and effectively configured into PA Hub. This pharmacist will also conduct clinical reviews of prior authorization (PA) requests and support special projects and clinical operations as business needs evolve.

Role and Responsibilities

Configure clinical criteria for medication prior authorizations into Agadia PA Hub
Conduct clinical reviews of PA requests and perform peer-to-peer discussions with prescribers as needed
Apply sound clinical judgment to assess medication use based on disease states and conditions
Develop and implement procedures to support efficient and clinically appropriate PA review processes
Serve as a clinical resource in conversations with providers and internal teams
Collaborate across teams to support clinical program operations and special projects
Stay current with clinical guidelines, drug information, and healthcare regulations.
Assist with clinical program operations and special projects as required according to business needs

Requirements

Doctor of Pharmacy (PharmD) or BS in Pharmacy with equivalent experience
Active pharmacist license in good standing in any U.S. state
At least 3 years of experience in a pharmacy benefit manager (PBM) or health plan setting
Prior experience conducting clinical reviews for prior authorization in a managed care environment
Proficiency with Microsoft Office suite
Excellent organizational, written and verbal communication
Highly motivated and good interpersonal skills, self-starter
Excellent critical thinking skills, detail-oriented
Ability to adapt and perform duties efficiently whenever unexpected changes arise
Works well in a fast-paced environment
Knowledge of HIPAA regulations

Preferences

Experience configuring clinical criteria in Agadia PA Hub

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

This is a largely sedentary role; however, some standing, walking, bending, and reaching may be required. Regularly operates in an office or home office setting which involves utilizing a computer, mouse, keyboard, and occasionally operates other standard office equipment, such as printer, copier, phone. Travel may be required by either car or airplane, or a combination of multiple modes of transportation.

LucyRx is an independent, next-generation pharmacy benefit manager (PBM) redefining prescription care. Fueled by innovation and decades of leadership experience, LucyRx delivers better outcomes through its integrated specialty network, formulary marketplace, and next-day home delivery solutions.

Powered by its proprietary AI platform, LucyIQ™, the company provides real-time insights that support evidence-based clinical decisions, clear pricing, and exceptional service from U.S.-based pharmacy technicians. Partnering with more than 60,000 pharmacies, LucyRx serves over 1,200 clients nationwide.

Salary Description

$127,254 - $158,621

LucyRx

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Clinical Pharmacist - PA Hub Configuration and Reviewer