Remote Pharmacist | Work From Home

Job Overview

We are seeking a committed and empathetic RPh Advisor to become an integral part of our dynamic team. In this pivotal role, you will be responsible for evaluating and reviewing prior authorization requests, ensuring that informed coverage determinations are made in alignment with clinical criteria and plan design.

Key Responsibilities

• Evaluate prior authorization requests, focusing on insurance coverage and eligibility verification.
• Interpret clinical guidelines and collaborate effectively with healthcare providers and physicians to leverage your clinical expertise.
• Communicate coverage decisions promptly to healthcare providers, health plans, employers, patients, and other stakeholders, adhering to established approval and denial management processes.
• Provide direct assistance to Medicare Part D members and their providers regarding pharmacy benefits.
• Accurately establish cases for members and review clinical information to make well-informed decisions on requests.
• Conduct outreach to providers for any required additional information, ensuring compliance with relevant compendia and Medicare guidelines.
• Document all Medicare Part D requests accurately and timely to maintain adherence to Medicare standards while delivering a superior service experience for our members.
  
  

Required Skills

• A licensed Pharmacist in your state of residence.
• Strong clinical knowledge and ability to interpret clinical guidelines.
• Excellent communication and collaboration abilities with healthcare providers.
• Detail-oriented with a strong focus on compliance and documentation.
• Capable of maintaining a distraction-free home office environment with a reliable Ethernet connection.
  
  

Qualifications

• Prior authorization experience within Pharmacy Benefit Management (PBM) is preferred, while retail experience is not applicable.
• An appropriate home office setup conducive to effective remote work is necessary.
  
  

Career Growth Opportunities

We are dedicated to fostering the professional growth of our employees. You will have access to training and advancement opportunities within our organization, helping you to successfully navigate the healthcare journey for our members.

Company Culture And Values

Our organization cultivates a supportive and collaborative environment that prioritizes exceptional service. We value each team member’s contributions and strive to achieve our mission of providing best-in-class experiences for our members.

Compensation And Benefits

• Comprehensive benefits package available to full-time employees after 90 days of employment.
• A 401(k) plan with a company match offered to full-time employees following one year of service.
  
  

Join us in our mission to enhance the lives of our members by delivering exceptional support and service in their healthcare journey! Your expertise will not only be appreciated but also contribute to meaningful work that positively impacts the well-being of others.

Employment Type: Full-Time