Job Description

Join to apply for the Prior Authorization Pharmacist role at Moda Health . About Moda Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, we’re focused on building a better future for healthcare by offering outstanding coverage to our members, compassionate support to our community, and comprehensive benefits to our employees. We value diversity and inclusion and invite applicants who share this commitment. Position Summary We are currently seeking a skilled and dedicated pharmacist to join our clinical pharmacy team. In this role, you will focus on prior authorization functions, making coverage determinations and completing appeal requests using clinical expertise and established criteria. This is a full‑time, work‑from‑home position. Pay Range $101,855.89 – $129,864.20 (depending on experience). The role may be classified as hourly (non‑exempt) based on location; actual pay is based on qualifications and the minimum requirement determines the lower end of the range. Benefits Medical, Dental, Vision, Pharmacy, Life & Disability 401K – Matching FSA Employee Assistance Program PTO and Company Paid Holidays Required Skills, Experience & Education Current active and unrestricted Oregon Registered Pharmacist license, or eligibility for Oregon licensure obtained within 60 days of hire. Effective communication and interpersonal skills for interacting with providers, internal teams, and stakeholders. Commitment to service, professionalism, and organizational values. Ability to work well under pressure with frequent interruptions. Adherence to HR policies, Code of Conduct, and protection of confidential information. Preferred Skills Doctor of Pharmacy degree (Pharm.D.) Experience in clinical therapeutics for specialty drugs. Two to three years of managed care experience. Primary Functions Evaluate medication requests for coverage and conduct thorough clinical reviews. Provide prior authorization coverage for rotating weekends and holidays. Support urgent medication requests and internal pharmacist support. Perform coverage determination reviews across all lines of business. Participate in appeals and grievances processes. Conduct medical literature evaluations to support coverage decisions. Collaborate with providers and recommend medication edits. Respond to drug information requests with comprehensive documentation. Organize workload and prioritize assignments efficiently. Support quality assurance, staff training, and policy updates. Perform other related duties as assigned by management. Working Conditions & Contact With Others Remote or hybrid with extensive PC and keyboard work; may exceed 40 hours/week including evenings and weekends. Collaboration with clinical pharmacy, analytics, sales, underwriting, healthcare services, benefits, legal, and external partners such as PBMs and manufacturers. Equal Employment Opportunity Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status, or any other protected status. This applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, and benefits. For more information regarding accommodations, please direct your questions to Kristy Nehler & Danielle Baker via our humanresources@modahealth.com email. To apply, please submit your application through our company page: #J-18808-Ljbffr Moda Health

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