Clinical Pharmacist Specialist
2 days ago
The Clinical Pharmacist Specialist will play a key role in conducting clinical reviews of medical data to support prior authorization for specialty medications. This operation-based role requires strong clinical knowledge and analytical skills to plan and execute approved criteria for prospective and concurrent reviews of cases.
Key Responsibilities:
- Collaborate with the CRU Technician to process referrals, including answering clinical questions, collecting relevant clinical/medical data, and conducting reviews in accordance with healthplan/employer agreed criteria within designated service level agreements.
- Coordinate timely communication of case decisions to physicians, health-plan/employers, patients, and other healthcare professionals following agreed-upon approval and denial management processes.
- Handle inbound phone calls and escalations from physicians or patients regarding prior authorization.
- Establish and maintain communication with health plan and employer group staff.
- Maintain professional and technical knowledge of drug and disease-states for the Specialty Pharmacy programs administered within the Case Review Unit.
- Perform other related projects and duties as assigned, including on-call and after-hours pharmacist availability.
Requirements:
- 0-3 years of work experience in a customer service position with high-volume call center experience, preferably in healthcare, social services, or a similar service position.
- High School Diploma or GED required; Bachelor's degree in a related field or equivalent work experience preferred.
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. We are an Equal Opportunity Employer and welcome applications from qualified candidates without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
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