Pharmacist

divh2Pharmacist/h2pIntegrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing./ph3Job Description/h3pLocation: Philadelphia, PA 19113./ppJob Description:/pulliReviews physician inquiries for pharmacy, physician-administered, or home infusion pre-authorization and medical necessity requests based on established pharmacy guidelines and contract criteria. Forwards initial denials to appropriate queue for further review. Generates notification letters to members and physicians on approved and denied requests./liliHandles calls and correspondence from providers; responds to inquiries, complaints, and reconsiderations. Documents call in inquiry tracking system. Using established protocols ensures resolutions provided are presented in a clear and accurate manner. Receive escalated calls that cannot be clinically resolved by 1st level intervention. Researchers resolve and respond to provider clinical inquiries./liliSupports Fraud and Abuse program system oversight. Communicates any suspected fraud discovered by the contact center staff. Recommends a course of action for providers where patterns appear outside of guidelines and generally accepted pharmacy standards./liliServes as second-line contact for all internal pharmacy related issues. Functions as a clinical liaison between internal staff and pharmacy network participants. Ensures internal changes that may affect network services are reflected in the claims processing system./liliConducts research necessary to maintain Prior Authorization Criteria, including therapeutic category and comparative drug review. Works with appropriate individuals/vendors to facilitate compliance. Responds to and drafts correspondence to physicians regarding requests on Drug Formulary. Responds to telephone inquiries from physicians, other healthcare professionals and members regarding select drug information./liliKeeps abreast of industry trends and regulatory changes in the pharmacy industry and evaluates their effect on pharmacy contracts and services. Makes recommendations on program improvements, based on findings and utilization. Assures compliance with PerformRx policies and procedures regarding pharmacy protocol./liliParticipates in various Pharmacy-related projects. Performs appropriate research, analysis and generates findings report. Submits recommendation to Manager for review and input. May assist in the implementation and/or coordination of project changes./liliSupports the MTM/DTM program through activities which may include the following: Performs medication therapy reviews to identify medication related problems, performs interactive consultations and makes recommendations/interventions for members and providers, appropriately documents all pharmacotherapy interventions, responds to questions and provides clarification for requests generated in regards to MTM/DTM programs./liliHas attended or attends MTM/DTM certificate training./liliComplies with URAC/CMS standards and regulation for DTMP./liliPerforms other related duties and projects as assigned. Attends required training on an annual basis./li/ulh3Qualifications/h3ulliCurrent pharmacy license, Commonwealth of Pennsylvania preferred./liliPharm D. preferred./lili2 years pharmacy experience preferred./liliPrevious experience in managed care environment preferred./liliMTM/DTM certificate training preferred./li/ulh3Additional Information/h3pRegards,/ppRiya Khem/ppLife Science Recruiter/ppIntegrated Resources, Inc./ppIT Life Sciences Allied Healthcare CRO/pp(Direct) View phone number on click.appcast.io | (W) View phone number on click.appcast.io | (F) View phone number on click.appcast.io/ppINC 5 0 0 0 s FASTEST GROWING, PRIVATELY HELD COMPANIES (8th Year in a Row)/p/div

Careers Integrated Resources Inc