Pharmacist - RPh Operations Advisor - Specialty Medical Prior Authorization

6 days ago

Texas City, United States Integrated Resources Full time

RAMP TIMELINE: - Date to Open: 10/7 - Offer Deadline: 11/4 - Offer Acceptance Timeline: 11/7 - Last Day To Clear: 11/22 Safety Sensitive 7am to 12am CST - 8 hours per day expected Possible weekend shifts The position is remote. MAX BILL RATE CLINICAL PHARMACIST - Specialty Medical Prior Authorization This is a safety sensitive position. Completion of all screens is required prior to the candidate starting the assignment. Upon acceptance please send the following information: Home address Personal email address Cell phone number broadband connection and a smartphone are required. The VPN token will need to be downloaded to the user's smartphone. NOTE: They can reside anywhere in the continental U.S. with the exclusion of New Mexico and Colorado candidates. Position Summary: The clinical pharmacist is an operation based role that conducts clinical reviews of medical data collected to perform prior authorization for specialty medications. The clinical pharmacist will apply clinical knowledge to plan approved criteria for prospective and concurrent reviews of cases. This role will work from Client Caremark supported systems and take inbound calls from physician or members regarding their pending, approved, or denied prior authorizations. Duties: This individual must have excellent interpersonal and organizational skills. Will be responsible for: 1. Collaborating with Technicians and Nurses to process authorization requests, including answering clinical questions, 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. (20%) 2. Coordinating timely communication of case decision to physician, health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes. (15%) 3. Handling inbound phone calls and escalations from physicians or patients regarding Prior Authorization (50%) 4. Establishing and maintaining communication among Client Caremark, health plan and employer group staff. (5%) 5. Maintaining professional and technical knowledge of drug and disease-states for the Specialty Medical programs administered within the Novologix platform. (5%) 6. Performing other related projects and duties as assigned. On call and after hours pharmacist availability may be required. (5%) Experience: Minimum of 2-5 years experience is preferred. Experience using MS Office and other Windows based computer applications, strong organizational skills, interpersonal skills, and detail orientation are important for this position. Required certification: Active pharmacist license in state of residence in good standing Education: Bachelor's degree in pharmacy or Pharm D. with at least two years experience as a pharmacist. Must have an active license in good standing.

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