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Pharmacist

ICONMA

Role overview

Qualifications

  • High School Diploma or GED required
  • Bachelor's Degree - BS Pharmacy and an active pharmacist license
  • Previous pharmacy experience in PBM preferred
  • Basic computer skills required

Responsibilities

  • Evaluate and review all prior authorization requests and render coverage determinations
  • Collaborate with technicians and prior authorization team to process referrals
  • Maintain professional and technical knowledge of drug and disease states
  • Perform other related projects and duties as assigned

Key facts

Hard skills

Other skills

  • Problem Solving
  • Organizational Skills
  • Social Skills
  • Detail Oriented
  • Communication

About the company

ICONMA logo

ICONMA

Management Consulting

We provide Professional Staffing Services & Project-Based Solutions for a broad range of Fortune 500 organizations. ICONMA is a certified Woman-Owned staffing company and was founded in 2000. ICONMA’s corporate headquarters is in Troy, Michigan, and has 15+ locations worldwide. What makes ICONMA stand out in a fiercely competitive industry? *We provide integrated, full lifecycle services across a broad range of business and technical platforms. *No single company can duplicate our full range of staffing and permanent recruiting services nationwide. *Proven track record of attracting and retaining exceedingly skilled professional workers in a highly competitive market. SERVICES OFFERED Staff Augmentation (Contract, Contract to Hire, Direct Hire, Single Source) Data Analysis Project-Based Services & Solutions Hire Train Deploy Service Model Offshore Staff Augmentation Payroll Services AREAS OF EXPERTISE - Information Technology - Engineering - Business Professional - Accounting/Finance - Admin/Clerical/Call Center - Healthcare/Clinical/Scientific - Marketing/Creative mail linkedin@iconma.com Phone (888) 451-2519 Website http://www.iconma.com

Company details

Company typeLarge
IndustryManagement Consulting
Company size1001 - 5000

Links

Website LinkedIn See all jobs

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Job description

Our client, a Retail Pharmacy company, is looking for a Pharmacist for their Remote location.
 
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. (60%)
  • Collaborates 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 inbound 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. (25%)
  • Maintains professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered within the Commercial Specialty line of business.(10%)
  • Performs other related projects and duties as assigned, including attending training sessions and development meetings, and providing on-call and after-hours pharmacist availability as needed.(5%)
  • The Pharmacist/Clinician is an operation-based role that conducts criteria based & clinical review of medical data collected to perform prior authorization as per policy and procedure.
  • The Pharmacist/Clinician will apply clinical knowledge to plan approved criteria for reviews of cases.
  • This role will work from Client supported systems and take inbound calls from physicians or members regarding their pending, approved, or denied prior authorizations, internally support the Prior Auth team and member services department, as well as provide on-call after hours availability for urgent PA request as needed.
 
Requirements:
  • Verifyable High School Diploma or GED Required
  • Previous pharmacy experience in PBM preferred.
  • Appropriate state license required.
  • Basic computer skills required.
  • Strong organizational skill, interpersonal skills and detail orientation important for this position.
  • Required: 1 to 3 years
  • Preferred: 3 to 5 years
  • Required: Bachelor's Degree - BS Pharmacy and an active pharmacist license in the state of practice/residence.
  • Preferred: Doctorate - Pharm D
 
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MR

Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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