Pharmacy - Pharmacist

Prior Authorization PharmacistPharmacist Specialty: - Duration: 8 Shift: Full time Hours per Shift: 35 Experience: One (1) year of Pharmacist experience required License: Valid license to practice as a Pharmacist Certifications: Primary Source Verification required Must-Have: Pharmacy dispensing system experience Sterile processing experience IV room experience Knowledge of an EMR (Electronic Medical Records system)Description: Reviews medical drug prior authorization and appeal requests for all lines of business. Renders coverage determinations based on preferred drug strategies, available benefits, internal criteria, and clinical judgment. Assists in responding to internal and external inquiries related to prior authorization review, including weekends and holidays. Identifies inappropriate utilization during claims and prior authorization review. Performs audits as necessary of vendor or internally reviewed cases to ensure all clinical, organizational, and operational standards have been met. Completes medication reviews for members to ensure safe and efficacious therapy. Assists in organizational and departmental quality improvement initiatives. Responds to pharmacy benefit-related inquiries. Participates in quarterly Pharmacy and Therapeutics meetings. Creates and reviews prior authorization criteria for medications as needed.