Prior Authorization Pharmacist

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

We’re looking for a Prior Authorization Pharmacist to join our Clinical Pharmacy team. Our team uses evidence-based practice through utilization review to ensure our members get access to the right care - those who need it most.About the role:

The Prior Authorization Pharmacist will perform clinical review of prior authorization requests and appeals for drugs under the pharmacy and medical benefit using clinical policies and Oscar formularies. Your daily tasks also include addressing escalations and questions from our teams, and outreaching to providers to conduct peer-to-peer discussions.

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 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, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, 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 …