Clinical Pharmacist

Clinical Pharmacist--Prior Authorization (Montvale NJ)

Empi Rx Health is the leading clinically-driven pharmacy benefits management company. As the pioneer in value-based pharmacy care, Empi Rx Health puts its customers and members first by enabling them to take control of their pharmacy benefits, healthcare outcomes, and financial results.

We place more emphasis on member care than any other PBM by focusing on health outcomes first. Our pharmacists and clinicians are at the center of everything we do―and our population health solution delivers tailored strategies for our clients. Leveraging our newly launched, AI-powered pharmacy care platform, Clinically ™ , Empi Rx Health’s pharmacists and client experience teams provide the highest quality pharmacy care to our clients and their members.

This enables benefits plan sponsors to keep their members healthy, happy, and productive, while substantially reducing prescription drug spending, which has been on an explosive growth trajectory in recent years.

The Clinical Pharmacist – Prior Authorization ensures clinical prior authorization and appeal determinations are completed in accordance with covered plan design while ensuring clinically appropriate pharmacy care and sustainable clinical savings for clients. This role supports Empi Rx Health’s Population Health Management model through collaboration, evidence-based decision-making, and proactive engagement with providers to drive optimal clinical and financial outcomes.

• Act as a clinical expert on prior authorization review and evaluation in accordance with clinical criteria and covered plan design.
• Conduct thorough evaluations and resolutions of assigned clinical reviews by performing in-depth case analyses and collaborating directly with physicians, in alignment with Empi Rx Health’s Population Health Management framework.
• Perform peer-to-peer reviews with providers as needed or when requested.
• Convey clinical determinations promptly within established turnaround time requirements to prescribers, members, and healthcare professionals following established approval and denial protocols.

• Monitor and proactively identify clinical interventions to ensure clinical savings guarantees are met.
• Review and evaluate current clinical literature to support decision‑making and provider recommendations.
• Participate in continuous quality improvement initiatives to streamline review processes and enhance member care.
• Stay informed about Empi Rx Health formulary changes, clinical programs, and internal policies and protocols.

• Provide guidance and support to members, providers, and healthcare professionals regarding clinical inquiries.
• Collaborate with clinical technicians and Clinical Account Executives to facilitate review requests, resolve escalations, and answer inquiries.
• Act as a clinical resource for internal staff, supporting staff training and development as needed.
• Collaborate cross‑functionally with internal teams for claim/data review, clinical interventions, and provider, member, or client support as required.

• Proficiently utilize pharmacy management software for documentation and communications.
• Proficiently utilize Microsoft Office tools to support analysis and reporting.
• Utilize external clinical and drug information databases (e.g., IPD, Up To Date , Medi Span) to support reviews, decisions, and awareness of emerging drugs.

• Pharm.
  
  D. degree from an accredited college of pharmacy (Preferred).

• Minimum of 3 years of pharmacy experience in clinical, PBM, or managed care settings. Prior experience with prior authorization, utilization management, or health plan operations preferred.

• Active Pharmacist License in good standing (Required).
• MTM or other specialty certifications preferred.

• Strong clinical judgment and analytical skills.
• Exceptional written and verbal communication with a comfortability of speaking with providers and medical staff.
• High attention to detail and accuracy in…