Prior Authorization Pharmacist
Pride Health is hiring remote contract to hire Prior Authorization Pharmacists in MST / PST time zones! New Grads are welcome to apply! Candidates must live in one of the following states : Nevada, Arizona, New Mexico, Utah, Montana, Idaho, Oregon, and Colorado.
This is a call center business segment. The pharmacist’s 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.
Schedule : Will work 8-hour days 5 days a week which may or may not include a weekend day(s), and must be available as early as 5 am and as late as midnight.
Pay : $54-$62 hourly
Contract : Contract to hire position
Primary Responsibilities :
- Establish and process member prescriptions or prior authorizations through various computer systems ensuring the accuracy of all data and updating as necessary.
- Work is computer-based and includes 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 the 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.
- Perform all duties and functions in compliance with state and federal pharmacy laws and regulations
- Conform with and support department quality assurance and improvement guidelines.
Requirements :
- Active Pharmacist License in good standing within the state of residence (NV, AZ, NM, UT, MT, ID, OR, and CO)
- Prior Authorization experience preferred
- New Grads are welcome to apply!
Apply today!
Pride Global offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.
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