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Shift: Monday - Friday 10am to 6:30pm EST
Duties: As a licensed healthcare professional employed in the Prior Authorization Department the primary responsibility of Pharmacist (R) is to make determinations on prior authorization requests for coverage of pharmaceutical products. Determinations include medical necessity and benefit decisions. Decisions are made in accordance with established pharmacy guidelines, prior authorization criteria, industry regulations and sound clinical judgment. Prior Authorization Pharmacist (R) works independently with respect to reviews and decision making, with the support of Pharmacist II (R)s and supervisors. Pharmacist (R) works as a member of a team of peers committed to meeting or exceeding quality standards and customer performance guarantees.
Additional responsibilities include:
Telephonically provide clinical support to the PerformRx Contact Center
Engage providers in discussions to support determinations
Support Fraud and Abuse program system oversight.
Participate in various Pharmacy-related projects
Keep abreast of industry trends and regulatory changes
Keep abreast of operational directives and customer reference materials.
Skills:
2 years pharmacy experience preferred.
Previous experience in managed care environment preferred.
Education:
Bachelor's degree required
PharmD preferred.
Current Pharmacist License
Required Skills:
CLINICAL SUPPORT
PHARMACY
MANAGED CARE
PHARMD
Ohm Systems
