Prior Authorization Pharmacist
Oscar Health
Hi, we're Oscar. We're hiring a Prior Authorization Pharmacist to join our Pharmacy team.
Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.
About the role
As a Prior Authorization Pharmacist, you will be a reviewer of prior authorizations.
You will report to the Clinical Pharmacist Team Lead.
Work Location:
Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission.
If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.
You must reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote
Pay Transparency:
The base pay for this role is: $108,000 - $141,750 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program)) and annual performance bonuses.
Responsibilities
- Review and render decisions on authorizations and appeals for specialty, non-specialty, and physician administered drugs
- Conduct peer-to-peer calls with prescribers to discuss the clinical rationale of adverse determinations
- Participate in clinical quality audits and inter-rater reliability testing
- Provide internal team support for escalations and questions
- Apply clinical expertise to ensure appropriate and safe use of pharmaceuticals by members and providers.
- Compliance with all applicable laws and regulations
- Other duties as assigned
Qualifications
- 3+ years of experience as a licensed pharmacist
- Active, unrestricted pharmacist license
- Doctor of Pharmacy Degree
- Willingness to obtain licensure/training with new states
Bonus Points
- 3+ years of experience performing clinical review in a managed care setting and experience writing clinical criteria
- Clinical experience applying clinical criteria in clinical review setting
- Board Certification (i.e. BCPS, BCOP)
- Residency training
- Experience practicing pharmacy in a clinical setting (i.e. retail, hospital, specialty)
This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.
Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.
Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.
California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Notice to Job Applicants.