Remote Prior Authorization Pharmacist - PBM | WFH

Job Overview

We are seeking a dedicated PBM Prior Authorization Pharmacist to join our team in a remote capacity. In this role, you will leverage your clinical expertise to conduct thorough reviews of medical data for specialty medications, ensuring adherence to approved criteria for prior authorizations.

Key Responsibilities

In This Operational Role, Your Primary Responsibilities Will Include

• Performing clinical reviews of medical data to facilitate prior authorization for specialty pharmaceuticals.
• Applying your clinical knowledge to execute both prospective and concurrent reviews effectively.
• Managing inbound inquiries from healthcare professionals and members regarding their prior authorization statuses, whether approved or denied.
• Collaborating with the Case Review Unit (CRU) Technician to address clinical inquiries and gather pertinent medical data for thorough assessments.
• Ensuring prompt communication of case determinations to relevant healthcare parties, including physicians and health plans, while adhering to the established approval and denial processes.
• Handling escalated calls from physicians or patients concerning prior authorization queries.
• Maintaining current knowledge of drugs and disease states associated with Specialty Pharmacy programs within the Case Review Unit.
  
  

Required Skills

To be successful in this role, candidates should possess:

• Strong clinical acumen related to specialty medications.
• Exceptional communication and interpersonal abilities.
• Proficiency in managing prior authorization processes.
• Capacity to collaborate effectively within a team environment.
• Excellent problem-solving capabilities.
  
  

Qualifications

The ideal candidate must meet the following qualifications:

• A minimum of 1 year of recent experience in PBM prior authorization.
• An active and valid Pharmacist license in your state of residence.
• A commitment to regular attendance, especially during the initial 90 days of employment.
  
  

Career Growth Opportunities

This position presents a contract opportunity with the potential for permanent employment contingent upon attendance, performance, and business requirements. As part of our team, you will have access to significant career advancement and development prospects within our organization.

Company Culture and Values

Our organization values a supportive and collaborative work environment that prioritizes teamwork and effective communication. We are committed to fostering a diverse workplace where all employees can thrive and contribute meaningfully.

Compensation And Benefits

We offer a comprehensive benefits package to full-time employees after 90 days of employment, which includes:

• Health, optical, dental, life, and short-term disability insurance.
• A 401(k) plan with a company match available after one year of service.
  
  

If you are ready to elevate your career as a PBM Prior Authorization Pharmacist and make a meaningful impact in the specialty pharmacy sector, we encourage you to apply today!

Employment Type: Full-Time