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Pharmacist - Prior Authorizations

ICONMA

Key Facts

Remote From: 
California (USA)
Category:  Pharmacist
Full time
Mid-level (2-5 years)
English

Roles & Responsibilities

  • Bachelor’s degree in pharmacy or PharmD
  • Minimum 2 years’ recent experience reviewing and processing prior authorizations
  • Excellent organizational skills
  • Strong Microsoft Office skills

Requirements:

  • Evaluate and review all prior authorization requests and render coverage determinations
  • Verify insurance coverage and eligibility, consulting with physicians and healthcare providers
  • Ensure timely communication of decisions regarding prior authorization cases
  • Collaborate with technicians and team members to process referrals and answer clinical questions

Job description

Our Client, a Retail Pharmacy company, is looking multiple Pharmacists with prior authorization experience to work remotely.

Responsibilities:
  • Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design.
  • Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols.
  • One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval & denial management processes.
  • Collaborate with the technicians and prior authorization team members to process referrals, including answering clinical questions and collecting appropriate clinical/medical data needed to perform clinical assessments and reviews as per the health plan/employer- agreed criteria within the designated service level agreements.
  • Performs and handles in bound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations.
  • Maintain professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered within the Commercial Prior Authorization and Case Review Unit (CRU) line of business.
  • Perform other related projects and duties as assigned, including attending training sessions and development meetings, and providing on-call and after-hours pharmacist avail ability as needed.
  • Demonstrated experience using clinical resources, e g., Micromedex, Lexicomp, Clinical Pharmacology
  • Ability to prioritize, quickly assess, manage multiple tasks and adapt to constantly changing situations.
 
Requirements:
  • Excellent organizational skills. Strong detail orientation.
  • Strong Microsoft Office skills.
  • Ability to receive phone calls from prior authorization pharmacy technicians and/or providers for clinical information.
  • Minimum 2 years’ recent experience reviewing and processing prior authorizations against health plan criteria for a determination in a specialty/skilled clinical setting i.e., specialty medical office or Pharmacy Benefits Manager (PBM)
  • Bachelor’s degree in pharmacy or PharmD
 
Why Should You Apply?  
ICONMA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to any status protected by applicable law.
 
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