Prior Authorization Pharmacist Advisor

A-Line Staffing is now hiring a Remote Prior Authorization Pharmacist ! This role offers an opportunity to work for a Fortune 500 company with career growth potential in a fully remote capacity. Highlights Pay: $53.00 per hour Hours: 7:00 AM – 8:00 PM EST Monday – Friday, 7:00 AM – 4:30 PM EST Saturday and Sunday (set rotation) Location: Remote / Work from Home (must have dedicated, quiet workspace) Type: Full-time, contract Training: First 8 weeks M-F, 9:00 AM – 5:30 PM EST (attendance mandatory) Responsibilities Support Medicare Part D members and providers with pharmacy benefit and prior authorization requests. Ensure accurate case setup and complete clinical review of prior authorization and Medicare appeals in compliance with CMS guidelines. Review clinical information and make appropriate determinations based on drug compendia and clinical judgment. Conduct provider outreach for additional clinical clarification when necessary. Accurately document all prior authorization and Medicare Part D requests and maintain compliance with CMS-mandated timelines. Meet or exceed departmental productivity and quality standards. Requirements Bachelor’s Degree in Pharmacy or Doctor of Pharmacy (PharmD) required. Active pharmacist license in the state of residence (must provide proof). Strong attention to detail and ability to work independently in a remote environment. Proven ability to apply clinical judgment and interpret drug compendia resources. Prior experience in Medicare Part D, prior authorizations, or pharmacy benefit management preferred. Computer literate with knowledge of Excel, Word, and preferably Access, PowerPoint, and Visio. Must provide internet speed test (minimum 25 Mbps download / 5 Mbps upload) and have a dedicated, quiet workspace. Benefits Benefits available to full-time employees after 90 days. 401(k) with company match available after 1 year of service on eligibility dates. Perform basic nursing care and treatments Teach the nurse delegation for nursing assistant classes Assisting in analyzing medical records Review medical records to analyze treatments verses standards of care/ medical necessity Provide clinical support to assigned skilled nursing centers Analyze and summarize medical records Analyze medical portions of legal documents Enhance the quality of patient care by providing consultation to care providers and nurse educators Reviewing medical records and preparing chronologies Identify applicable standards of care in medical malpractice cases Work closely with all nursing staff as a clinical preceptor to provide and evaluate hands on patient care Organize, review and summarize medical records to determine compliance with standard of care Organize, review and summarize medical records to determine compliance with standards of care Facilitate education and orientation of the nursing staff Document clinical workflow in the various care area departments Cultivate nursing leadership support network Foster nursing leadership support network Ensure the practice of nursing Serve as a clinical resource for patient care staff throughout the hospital Transitioning nursing facilities to pharmacy's services