Prior Authorization Pharmacist

Oscar

Prior Authorization Pharmacist at Oscar Health reviewing drug authorizations and appeals for members. Collaborating with prescribers and participating in clinical audits while ensuring compliance with regulations.

Posted 5/12/2026full-timeRemote • Alabama, Arizona, Colorado, Connecticut, District of Columbia, Florida, Idaho, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia • 🇺🇸 United StatesMid-LevelSenior💰 $111,780 - $146,711 per yearWebsite

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

3+ years of experience as a licensed pharmacist
2+ years of experience performing prior authorization review in a managed care setting
Active, unrestricted pharmacist license
Doctor of Pharmacy Degree
Willingness to obtain licensure/training with new states

Benefits

Comp & perks

employee benefits
participation in Oscar's unlimited vacation program
annual performance bonuses

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

prior authorization reviewclinical quality auditsinter-rater reliability testingclinical expertisepharmaceutical safety

Soft Skills

communicationteam supportproblem-solving

Certifications

licensed pharmacistDoctor of Pharmacy Degree