Remote Pharmacist | Work From Home

Job Overview

We are excited to welcome a committed and empathetic RPh Advisor to our dynamic team! In this pivotal role, you will be instrumental in evaluating and processing prior authorization requests, making informed coverage determinations grounded in clinical criteria and plan design.

Key Responsibilities

• Assess prior authorization requests with a focus on verifying insurance coverage and eligibility.
• Analyze clinical guidelines and collaborate with healthcare professionals to effectively apply your clinical expertise.
• Communicate coverage decisions promptly and efficiently to healthcare providers, health plans, employers, patients, and other relevant parties, adhering to our approval and denial management processes.
• Offer direct assistance to Medicare Part D members and providers regarding their pharmacy benefits.
• Accurately prepare cases for members and review clinical information to make well-informed decisions on requests.
• Conduct outreach to providers for additional information as needed, ensuring compliance with relevant compendia and Medicare guidelines and timelines.
• Document all Medicare Part D requests meticulously and promptly to maintain compliance with Medicare standards while delivering a best-in-class service experience for our members.
  
  

Required Skills

• Licensed Pharmacist in the state of residence.
• Prior authorization experience within Pharmacy Benefit Management (PBM) is preferred; retail pharmacy experience is not applicable.
• An effective home office setup that ensures a distraction-free work environment and a reliable Ethernet connection.
  
  

Career Growth Opportunities

We are dedicated to the professional growth of our employees, encouraging exploration of career advancement opportunities within our organization. You will have access to resources that support continuous learning and career aspirations.

Compensation And Benefits

• Comprehensive benefits package available for full-time employees after 90 days of employment.
• A 401(k) plan with company matching offered to full-time employees after one year of service, aligning with our eligibility dates.
  
  

Join us in our mission to enhance the healthcare journey of our members by providing unparalleled support and service!

Employment Type: Full-Time