This position involves working as a Clinical Pharmacist within the Prior Authorization unit. The role is primarily centered around reviewing Prior Authorization cases and making coverage determinations based on clinical criteria and plan design.
The work environment is fast-paced and dynamic, with a focus on computer-based tasks.
Primary Responsibilities :
- Receive phone calls from prior authorization pharmacy technicians and / or providers to provide clinical information.
- Consult with physicians / providers, interpret clinical guideline criteria, and review coverage determinations for prior authorization cases.
- Collaborate with pharmacy technicians and physicians to advise on appropriate formulary alternatives for medications.
- Analyze complex clinical information, coverage policies, and criteria to make informed coverage determinations.
- Organize workload, set priorities, and complete assignments in a timely manner while adhering to department standards.
- Ensure compliance with state and federal pharmacy laws and regulations.
- Support department quality assurance and improvement guidelines.
- Build positive relationships with coworkers, internal customers, and other departments through excellent customer service.
Work Schedule :
- Training time is 8 : 00 am to 5 : 00 pm, Monday to Friday (subject to change).
- After training, the work schedule can range between 9 am and 9 pm.
- Candidates will work 5 days a week, which may include weekends based on business needs.
- Overtime and holiday work may be required.
Qualifications :
- Bachelor's Degree in Pharmacy or Doctorate in Pharmacy (Pharm D)
- Previous experience as a Pharmacist (1-3 years) is preferred.
- Customer service experience (1 year) analyzing and solving customer problems, or experience in an office setting using telephone and computer instruments, is preferred.
- Proficiency in PC skills (MS Word, Excel) is desirable.
Audrey SorberHealthcare
Clinical Pharmacist
This position involves working as a Clinical Pharmacist within the Prior Authorization unit. The role is primarily centered around reviewing Prior Authorization cases and making coverage determinations based on clinical criteria and plan design. Receive phone calls from prior authorization pharmacy ...
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