Role overview

Qualifications

Pharm D. required
Minimum of 2-5 years of clinical experience with prior authorization requests
Must have an active license in the state of residence in good standing
Experience using MS Office and other Windows based computer applications

Responsibilities

Collaborates with Technicians and Nurses to process authorization requests
Coordinates timely communication of case decision to physician, health-plan/employer, patient and other healthcare professionals
Handles inbound phone calls and escalations from physicians or patients regarding Prior Authorization
Establishes and maintains communication among health plan and employer group staff

Key facts

Remote from: Rhode Island (USA)
Fixed term
Mid-level (2-5 years)
Pharmacist
English

Hard skills

Prior Authorization Windows Software

Other skills

Microsoft Office
Organizational Skills
Social Skills
Detail Oriented

About the company

US Tech Solutions

Human Resources, Staffing & Recruiting

USTECH SOLUTIONS is the largest privately owned diversity workforce partner with a global footprint. For 20+ years, we have partnered with leading MSPs and some of the world’s largest enterprises to deliver a flexible workforce. We serve Fortune 500 giants and growing businesses alike, reinventing the role of humans in a digital workforce. ‘Reinventing Human’ is about connecting you with top talent and seamlessly integrating new hires into your programs through our next gen AI powered Talent platforms. As the largest private diversity supplier in the US, we champion inclusion and unlock hidden potential. We work with leading MSPs and are a trusted strategic partner to the world’s top brands. At USTECH SOLUTIONS, we're inverting the talent hiring pyramid by offering a range of solutions from curated talent pools, workforce management services, and IT services resourcing to IC compliance. Our legacy and close affinity to the computing industry has equipped us with the expertise and vision to provision AI platform solutions that help organizations to innovate faster. Considering Statement of Work? Meet US Tech Digital (ustechdigital.com). We're helping businesses achieve digital leadership through our tailored SOW solutions, utilizing market-leading technology products and our proprietary in-house developed platform solutions. Explore our full range of services and solutions by visiting our website: ustechsolutions.com

Company details

Company typeLarge

IndustryHuman Resources, Staffing & Recruiting

Company size1001 - 5000

Links

Website LinkedIn See all jobs

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Job description

Duration: 6+ months contract

Job Description:

The clinical pharmacist is an operation based role that conducts clinical reviews of medical data collected to perform prior authorization for specialty medications.
The clinical pharmacist will apply clinical knowledge to plan approved criteria for prospective and concurrent reviews of cases.
This role will work from Pharmacy supported systems and take inbound calls from physician or members regarding their pending, approved, or denied prior authorizations

Responsibilities:

Collaborates with the Technicians and Nurses to process authorization requests, including answering clinical questions, 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. (20%)
Coordinates timely communication of case decision to physician, health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes. (15%)
Handles inbound phone calls and escalations from physicians or patients regarding Prior Authorization (50%)
Establishes and maintains communication among health plan and employer group staff. (5%)
Maintain professional and technical knowledge of drug and disease-states for the Specialty Medical programs administered within the Novologix. (5%)
Performs other related projects and duties as assigned including on call and after hours pharmacist availability could be required. (5%)

Skills:

Prior Authorization
PBM

Experience:

Minimum of 2-5 years of clinical experience with or clinical review of prior authorization requests is preferred.
Experience using MS Office and other Windows based computer applications, strong organizational skills, interpersonal skills, and detail orientation are important for this position

Education:

Pharm D. required with at least two years experience as a pharmacist in Managed care environment.
Must have an active license in the state of residence in good standing.

About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com.

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity,
national origin, disability, or status as a protected veteran.

By applying, you acknowledge that AI-assisted tools may be used during hiring.

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