Clinical Pharmacist

Medical and Clinical Laboratory Jobs
Woonsocket, Rhode Island
June 8, 2026
$66 / hour
Contract
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Job Description

Job Summary:

  • The Prior Authorization Pharmacist is responsible for reviewing and evaluating medication prior authorization requests to ensure appropriate, safe, and cost-effective therapy in accordance with clinical guidelines, regulatory requirements, and organizational policies.
  • This role applies clinical judgement to support optimal patient outcomes while balancing utilization management objectives.

Duties and Responsibilities:

  • Review, assess, adjudicate medication prior authorization requests for medical necessity, clinical appropriateness, and formulary compliance.
  • Apply evidence-based clinical guidelines, drug compendia, FDA labeling, and plan-specific criteria to authorization decisions.
  • Evaluate patient-specific factors including diagnosis, laboratory results, prior therapy, dosing, contraindications, and comorbid conditions.
  • Authorize, modify, or deny medication requests and document clinical rationale clearly and accurately.
  • Collaborate with pharmacy technicians, nurses, medical directors, and other clinical staff to resolve complex cases.
  • Support peer-to-peer reviews and prepare clinical summaries when escalation is required.
  • Ensure compliance with state and federal regulations, accreditation standards (e.g. NCQA, URAC), and internal audit requirements.
  • Maintain productivity, turnaround time, and quality benchmarks for prior authorization processing.
  • Document all activities accurately within prior authorization and pharmacy management systems.

Education, Certifications/ Licenses:

  • High School Diploma or GED required.
  • Bachelor’s degree in pharmacy or Pharm D. also required with at least two years experience as a pharmacist.
  • Must have an active license in good standing.
  • Active and unrestricted Client or TX pharmacist license.

Skills and Experience:

  • Experience with clinical decision-making while applying evidence based clinical guidelines/criteria; utilizing formularies/preferred drug lists.
  • Experience working in a high production team environment.
  • 3+ years experience working as a pharmacist.
  • Knowledge of clinical program components, formulary designs, and prescription benefit trends.

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