Clinical Pharmacist
Axelon
Job Title
Pharmacy Reviewer
Job Description
Work Mode: 100% Remote
SHIFT: 9am – 6pm EST, NO OT
Duration: 3 months
Responsibilities
Review completed prior authorization requests from providers.
Verify member's ID number, date of birth, and eligibility in the health plan system.
Record carrier and group numbers if applicable.
Check previous prior authorization decisions and verify prescription and health plan benefits.
Evaluate prescription claim history and review chart notes/lab values.
Identify provider specialty when appropriate.
Apply Medical Policy Criteria to prior authorization requests.
Evaluate requests for approval using professional clinical judgment.
Research and contribute drug references and clinical information for prior authorization review.
Communicate with physicians regarding non-formulary drugs, plan benefits, exclusions, quantity limits, age restrictions, and formulary alternatives.
Retrieve and collect data through available reporting resources.
Compile data for reporting purposes, including drug utilization and audit pharmacy claims.
Requirements
Pharm D. required.
At least one year of professional RPh experience.
Any US state licensure.
Preferred Skills
Some experience working in managed care.
Understanding of Medicare/Medicaid law.
Vacancy posted 3 days ago
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