Job description

Job Description:
Shift start time: 9am CST or later - 8 hours per day expected; Tuesday-Saturday or Sunday-Thursday
Training dates: August 28th - September 6th, 2023; training time: 8am to 4:30pm CST

CLINICAL PHARMACIST POSITION SUMMARY:
The clinical pharmacist is an operation based role that conducts clinical reviews of medical data collected to perform prior authorization for specialty medications. The clinical pharmacist will apply clinical knowledge to plan approved criteria for prospective and concurrent reviews of cases. authorizations.

Responsibilities

Collaborates with the CRU Technician to process referrals, including answering clinical questions, collecting appropriate clinical/ medical data needed to perform clinical assessments, and reviews as per the healthplan/employer agreed criteria within the designated service level agreements. (20%)
Coordinates timely communication of case decision to physician, health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes. (15%)
Handles inbound phone calls and escalations from physicians or patients regarding Prior Authorization (50%)
Establishes and maintains communication, health plan and employer group staff. (5%)
Maintain professional and technical knowledge of drug and disease-states for the Specialty Pharmacy programs administered within the Case Review Unit. (5%)
Performs other related projects and duties as assigned including on call and after hours pharmacist availability could be required. (5%) Knowledge of Access, Power Point, and Visio is preferable. Must be computer literate – knowledge of Excel and Word. Licensed Registered Pharmacist 3+ years experience is preferred.
This is a safety sensitive position. Completion of all screens is required prior to the candidate starting the assignment. Upon acceptance please send the following information: A broadband connection and a smartphone are required. The VPN token will be need to be downloaded to the user’s smartphone. NOTE: They can work from anywhere in the continental U.S. with the exclusion of New Mexico and Colorado candidates.

Duties

Answer phone lines promptly with priority on 'Pharmacist' line and escalated calls. Serves as the final decision-maker on all PA denials. Works distributed faxes. Maintains accurate documentation of calls. Works all client exceptions. Maintains and updates all desk references materials. Assures the proper processing and maintenance of all PA paperwork. Attends on going training and development meetings.

Experience

Prior authorization experience preferred. Previous pharmacy experience in retail or hospital preferred. Appropriate state license required. Basic computer skills required. Strong organizational skill, interpersonal skills and detail orientation important for this position.

Position Summary

The basic function of the pharmacist is to review and complete criteria based prior authorization as per policy and procedure and provide internal pharmacist support to the PA team and member services department.

Education

Bachelor's degree in pharmacy or Pharm D. Must have an active license in the state you reside in that is in good standing.
What days & hours will the person work in this position? List training hours, if different. Shift start time: 9am CST or later; Tuesday-Saturday or Sunday-Thursday

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