Prior Authorization Pharmacist - Temporary

Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.

Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.

Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.

Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.

We are currently seeking a skilled and dedicated pharmacist to join our clinical pharmacy team. In this role, you will have the exciting opportunity to focus on the vital prior authorization functions of our work. Your primary responsibilities will involve making coverage determinations and completing appeal requests, using your clinical expertise to provide coverage decisions based on established criteria, guidelines, and specific plan design.

You will be part of a dynamic environment where you can make a significant impact on patient care and contribute to the overall success of our healthcare organization.

$ - $ annually (depending on experience)

• This role may be classified as hourly (non-exempt) depending on the applicant's location. Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.

• Medical, Dental, Vision & Pharmacy
• PTO and Company Paid Holidays
• 401k - Matching

• Current active and unrestricted Oregon Registered Pharmacist license, or eligible for Oregon licensure which is to be obtained within 60 days of hire date
• Effective communication and interpersonal skills to interact with healthcare providers, internal teams, and external stakeholders
• Commitment to service, organizational values, and professionalism through appropriate conduct and demeanor always
• Works well under pressure with frequent interruptions and shifting priorities
• Follow the company HR policies, Code of Conduct, and all department policies and procedures including protecting confidential company, employee, and customer information

• Doctor of Pharmacy degree (Pharm.D.)
• Experience in clinical therapeutics for specialty drugs
• Two to three years of managed care experience

• Evaluate medication requests for coverage (e.g., prior authorization reviews, non-formulary requests, step therapy exceptions), conducting thorough clinical reviews and assessing their compliance with established clinical guidelines, formularies, and policies
• Provide prior authorization pharmacist coverage for rotating weekends…