Description: Our client is currently seeking a Pharmacist PA/Appeals to join their team!
Scope of Role:
Location: Remote
Hours: 8am-5pm PST
Job Engagement: Contract
This job will have the following responsibilities:
Collaborates with the coordinators and nurses 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.
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.
Performs and handles inbound and outbound phone calls with coordinators, nurse, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations.
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.
Qualifications & Requirements:
PharmD
2 years experience working as a Prior Authorization pharmacist
Experience using clinical resources, e.g., Micromedex, Lexicomp, Clinical Pharmacology
Pharmacist License in the state you reside
Contact: ehartzell@judge.com
This job and many more are available through The Judge Group. Find us on the web at www.judge.com
