Clinical Pharmacist, Prior Authorization

Company: Pharmacy Benefit Management
Location: New York City
Posted on: March 17, 2026

Job Description:

Job Description PAY: $120,000 - $135,000 a year OVERVIEW: District Council 37 (DC 37), New York City’s largest municipal union, is seeking a highly skilled, detailed-oriented and motivated pharmacist to support its Prior Authorization and Utilization Management functions. This role plays a critical part in ensuring DC 37 members receive timely, appropriate, and evidence-based access to medications in accordance with the Plan document, formulary, and applicable clinical guidelines. The Prior Authorization Clinical Pharmacist will conduct clinical reviews, collaborate with providers and internal stakeholders, and uphold the Union’s commitment to high-quality, cost-effective pharmacy benefits for its membership. ESSENTIAL DUTIES AND RESPONSIBILITIES a) Performs Prior Authorization reviews and coverage determinations as defined by pharmacy benefit design and established clinical treatment guidelines b) Manages all level of clinical review including Appeals c) Support and manage prescription benefit operations and ensure PBM aligns with benefit design d) Review and update PA guidelines for support of P&T committee and pharmacy benefit design e) Acts as support to Prescription Drug Unit staff and provides training and education where needed f) Meets assigned productivity, quality, and turnaround time metrics in compliance with regulatory and accreditation requirements across applicable lines of business g) Supports Disease Management initiative such as Adherence, Weight management, and Diabetes h) Collaborate with Pharmacy Director and other interdepartmental staff to communicate pharmacy strategies and clinical programs, initiatives and benefit changes i) Develops and maintains desktop procedures, workflows, and documentation to support PA operations j) Reviews and resolves complaints made by members and providers regarding Prior Authorization, formulary, or pharmacy benefit services k) Performs appropriate clinical literature review and evidence-based research l) Knowledge of utilizing LexiComp, Facts and Comparisons, Micromedex, UptoDate, National guidelines, NCCN, and relevant reference m) Collaborate to create clear communication to members and/or providers on prior authorization determinations n) Works in partnership with pharmacy staff to assist in the implementation of utilization management programs o) Works in collaboration with Director of Pharmacy to help with workflows and operational efficiencies p) Evaluate opportunities for operational or process improvements q) Support and manage other related benefit operations r) Ensures strict compliance with HIPAA and applicable privacy regulations while handling protected health information s) Performs reconciliation and reimbursement tasks This position assumes and performs other duties as assigned. WORK SCHEDULE Monday through Friday QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. REQUIRED Possess strong analytical skills and detail oriented Ability to work independently with minimal supervision Understanding of claims processing and claims edits Intermediate level proficiency with MS Office applications - Word, Power Point, Excel, and Outlook Ability to work in a dynamic and fast-paced environment 2 years of experience with performing prior authorization 1 year of experience with PBM or Managed Care setting EDUCATION and/or EXPERIENCE Doctor of Pharmacy (Pharm D) degree. PREFERRED QUALIFICATIONS 3 years as practicing pharmacist or 1 year as PGY-1 resident 2 years’ experience in a Managed Care Setting Knowledge of Medispan or First Data Bank and drug classification system Understanding of Drug-Cost Analysis BCPS certification Pharmacy Leadership/Teaching certification CERTIFICATES, LICENSES, REGISTRATIONS Must possess an active New York State Pharmacist license. WORK ENVIRONMENT Hybrid (3 days in the office, 2 days remote at the discretion of Director of Pharmacy after probationary period) The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is regularly required to sit; use hands to handle or feel; talk; and hear. BENEFITS Health, Dental and Vision Insurance Prescription Coverage Vision Insurance Paid Time Off and Paid Holidays 401(k) Pension Paid Holidays Disability Insurance

Keywords: Pharmacy Benefit Management, New York , Clinical Pharmacist, Prior Authorization, Healthcare , New York City, New York