Pharmacist

Our client, a Retail Pharmacy, is looking for a multiple Pharmacists with prior authorization experience. If you have an active, unrestricted Pharmacist license, and are looking for remote work - this job is for you!


Responsibilities:

• Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design.
  • Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols.
• Guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval & denial management processes. (60%)
• Collaborates with the technicians and prior authorization team members to process referrals, including answering clinical questions and collecting appropriate clinical/medical data needed to perform clinical assessments and reviews as per the health plan/employer-agreed criteria within the designated service level agreements.
• Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations. (25%)
• Maintains professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered within the Commercial Specialty line of business. (10%)
• Performs other related projects and duties as assigned, including attending training sessions and development meetings, and providing on-call and after-hours pharmacist availability as needed. (5%)
• Conducts criteria based & clinical review of medical data collected to perform prior authorization as per policy and procedure.
• Apply clinical knowledge to plan approved criteria for reviews of cases.
• Take inbound calls from physicians or members regarding their pending, approved, or denied prior authorizations, internally support the Prior Auth team and member services department, as well as provide on call after hours availability for urgent PA request as needed.

• Active Pharmacist License
• 2+ years of Prior Authorization review experience; PBM, Managed Care, or Health Plan experience strongly preferred
• Specialty Pharmacy experience is a plus
• Strong communication and documentation skills
• Required: Bachelor's Degree - BS Pharmacy; Preferred: Doctorate - Pharm D
• Basic computer skills required. Strong organizational skills, interpersonal skills and detail orientation important for this position.
• Required: 1 to 3 years experience; Preferred: 3 to 5 years
• High-speed reliable internet; minimal home broadband connectivity speed of 25 Mb download and 3 MB upload speed.
• Sufficient/private work area that is used for business during their work hours.

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities