Job Description

Direct message the job poster from Managed Staffing, Inc. Looking for Pharmacist with 2 years’ recent experience reviewing and processing prior authorizations against health plan criteria for a determination in a specialty/skilled clinical setting i.e., specialty medical office or Pharmacy Benefits Manager (PBM) experience. Job Summary: 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. One of the crucial responsibilities is to 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. Collaborate 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. Maintain professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered within the Commercial Prior Authorization and Case Review Unit (CRU) line of business. Perform 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. Duties: This position is a 100% remote, work from home opportunity and will not be patient facing. Demonstrated experience using clinical resources, e.g., Micromedex, Lexicomp, Clinical Pharmacology. Ability to prioritize, quickly assess, manage multiple tasks and adapt to constantly changing situations. Prior authorization, call center and/or clinical pharmacy experience. Excellent oral and written communication skills and interpersonal skills. Ability to work independently and make clinical decisions. Experience using MS Office and other Windows based computer applications. Ability to receive phone calls from prior authorization pharmacy technicians and/or providers for clinical information. Experience: Hold and maintain an active, unencumbered Pharmacist license in North Carolina. Position requires proficiency with computer skills which include multitasking, navigating multiple systems, and keyboarding. Experience using MS Office, other Windows based computer applications, web-based processing and telephony programs. Minimum 2 years’ recent experience reviewing and processing prior authorizations against health plan criteria for a determination in a specialty/skilled clinical setting i.e., specialty medical office or Pharmacy Benefits Manager (PBM). Education: Bachelor's degree in Pharmacy or PharmD. Seniority level Associate Employment type Contract Job function Health Care Provider Industries Hospitals and Health Care #J-18808-Ljbffr

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