Prior Authorization Clinical Pharmacist

3 weeks ago

Oklahoma City, United States National Health Care Solutions Full time
Organizational Information

We are a small, but rapidly growing PBM. Our culture is
important to us, so teamwork and open/honest communication are critical to
maintain a balanced work/life schedule. Most importantly, we encourage you to
have fun, maintain humor in your workday, and set that example for your team.
At Verus, we believe deeply in diversity and all of the fascinating
characteristics that make us each unique. We are focused on equality,
inclusion, and keeping up with a modern and progressive approach

DUTIES AND RESPONSIBILITIES

The essential functions include, but are not limited to the following:

  • Reviews, creates, or maintains various documents/reports used internally as well as publicly and ensures the information is correct.
  • Reviews criteria updates quarterly and implements PA software applications.
  • Performs various duties as needed to successfully fulfill the function of the position including prior authorization reviews, quality control, and criteria management.
  • Meet and/or exceed production, quality, attendance and adherence standards.
  • Provide/assist in training other employees.
Other job duties include, but are not limited to the following:
  • Perform other duties as assigned.
MINIMUM QUALIFICATIONS (KNOWLEDGE, SKILLS, AND ABILITIES)
  • Pharm.D. degree from an accredited university.
  • Strong clinical background in PBM, managed care or clinic practice settings (three years).
  • Excellent knowledge of all aspects of drug utilization management processes including, but not limited to, the development/ maintenance of coverage policies for quantity limits, step therapies, age/gender limits, prior authorizations, and the communication of drug utilization management program updates to internal colleagues and external clients.
  • Proficient in critical literature evaluation skills, including evidence-based medicine principles.
  • Active pharmacy licensure with no restrictions, in the state(s) of Licensure
  • Strong knowledge of MediSpan data system, including GPI drug classification system.
  • Proficiency in drug literature, clinical trials and national guidelines
  • Familiarity with prescription benefits claims processing and formulary design.
  • Excellent verbal and written communication skills.
  • Excellent organizational and time management skills.
  • Demonstrate dependability through good attendance and adherence to timelines and schedules.
  • Excellent follow through on projects and deliverables.
  • Excellent analytical skills.
  • Excellent problem-solving skills.
  • Demonstrate resourcefulness and ability to take initiative in development and completion of projects.
  • Strong customer service orientation and commitment to professionalism.
  • Strong proficiency in pc applications, including Microsoft Office.
  • Demonstrated ability to work collaboratively in a team environment.
  • Excellent interpersonal and problem-solving skills.


TO ALL RECRUITMENT AGENCIES: The
Company and its affiliates do not accept unsolicited agency resumes. Please do
not forward resumes for any of our job postings, to our careers sites, or to
any employees of the Company or its affiliates. We are not responsible for any
fees related to unsolicited resumes.

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