Prior Authorization Pharmacist

Market leading national managed care organization is looking for Prior Authorization Pharmacists to work remotely! Great opportunity, please call us today!

Duties:

- Review prior authorization requests and make determinations for drug products according to member benefits and coverage criteria

- Report to utilization review statistics to corporate compliance committees

- Review data and summarize daily utilization review numbers

- Responsible for tracking compliance of review cases

- Provide clinical guidance and support to the assigned pharmacy technicians

- Knowledge of drug coding (NDC, GCN, GPI and USC) and NCPDP claims adjudication systems

- Review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design.

- Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practices

- Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews

Qualifications: Must have an active NC Pharmacist license. 3-5 years experience. PBM, prior auth and managed care experience preferred.

Shift: M-F 8am-5pm EST

Potential for long term based on performance!

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact View email address on randstadusa.com.


Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).


This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.