Remote PBM Pharmacist - Prior Authorization | WFH

Job Overview

Join our esteemed organization as a Remote PBM Prior Authorization Pharmacist. This role offers the opportunity to collaborate with diverse teams to address clinical inquiries and meticulously gather essential clinical and medical information for thorough evaluations. You will play a vital role in conducting reviews aligned with the criteria set forth by health plans and employers, all while ensuring compliance with established service level agreements.

Key Responsibilities

• Collaborate effectively with various teams to resolve clinical queries and compile necessary data for impactful clinical evaluations (20%).
• Maintain timely and clear communication of case decisions to healthcare professionals, including physicians, health plans, employers, and patients, in accordance with established approval and denial processes (20%).
• Assess ongoing cases and deliver clinical judgments regarding Prior Authorizations, Tier Exceptions, and Non-Formulary requests (50%).
• Engage in additional related projects and responsibilities as required, including potential on-call duties or after-hours availability (10%).
  
  

Required Skills

• Proficiency in Microsoft Access, PowerPoint, and Visio is preferred.
• Strong computer literacy, particularly in Excel and Word.
  
  

Qualifications

• Must hold a valid license as a Registered Pharmacist in your state of residence.
• A minimum of 1 year of experience is essential; 2-5 years of experience is highly preferred.
  
  

Career Growth Opportunities

This position not only offers a chance to apply your expertise in a meaningful way but also provides pathways for professional development within a reputable organization.

Company Culture And Values

We pride ourselves on fostering a collaborative and inclusive workplace that encourages innovation and growth. As a member of our team, you will be part of a culture that prioritizes the well-being of our patients and the continuous improvement of healthcare services.

Networking And Professional Opportunities

Joining our team opens doors to invaluable networking opportunities, allowing you to engage with professionals across the healthcare sector and enhance your skills through collaborative efforts.

Compensation And Benefits

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

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

We invite you to contribute to shaping the future of healthcare while advancing your career in a supportive and progressive environment.

Employment Type: Full-Time