This position is for a Clinical Pharmacist working in the Prior Authorization unit
This is a call center based business segment and strict work guidelines are employed. The pharmacists primary role is reviewing Prior Authorization cases and rendering coverage determinations based on clinical criteria and plan design in a fast paced and dynamic environment.
Primary Responsibilities:
Work is computer based and include receiving phone calls from prior authorization pharmacy technicians and/or providers for clinical information
Consult physicians/providers with questions, interpret clinical guideline criteria, and render/review coverage determination for prior authorization cases
Consult with pharmacy technicians and/or physicians regarding use of medications and advise of appropriate formulary alternatives when requested.
Gather complex clinical information, coverage policy and criteria information and work within regulatory guidelines to make coverage determinations
Organize workload, sets priorities, completes assignments in a timely manner and utilizes resources appropriately while complying with department program standards
Perform all duties and functions in compliance with state and federal pharmacy laws and regulations
Conform with and supports department quality assurance and improvement guidelines
Dedication to build rapport with coworkers, internal customers, and other departments by demonstrating a strong customer service orientation and a continuous positive image of the company.
Demonstrate ability to maintain productive working relationships with team members, other internal and external customers, and management team.
Skill and Requirements:
Training is for 4 weeks. Training time is 8:00am-5:00pm. Monday- Friday.
Shift after training is an 8 hour shift with an hour lunch.
Candidate must be available as early as 5am and as late as midnight.
Candidate will work 5 days a week which may or may not include a weekend day(s).
There is scheduled Overtime and working on Holidays. Dependent on business needs, candidate could work up to 4 hours a day OT.
Candidate must have their own home internet access/VPN (internet can be hard wired with Ethernet cord)
Candidate must also have a secure work space/office in their home
Candidate must have level skill with working with PC (ex. using mouse and keyboard, accessing and navigating through multiple systems and screens)
Excellent Attendance is a must
Active state Pharmacist license.
Please email resume to mmabry@judge.com. Phone interviews will be set up accordingly
Contact: mmabry@judge.com
This job and many more are available through The Judge Group. Find us on the web at www.judge.com
