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Pharmacy Authorization Specialist

2 months ago

Philadelphia, Pennsylvania, United States vTech Solution Full time

Position Overview:

As a licensed healthcare professional in the Pharmacy Prior Authorization Department, your main duty is to evaluate prior authorization and coverage requests for pharmaceutical products. This involves making determinations regarding medical necessity and benefit eligibility.

These decisions are guided by established pharmacy protocols, contractual criteria, industry regulations, and sound clinical judgment.

The Prior Authorization pharmacist operates autonomously in conducting reviews and making decisions, while receiving support from senior pharmacy staff and supervisors.

You will collaborate with a team of peers dedicated to achieving or surpassing quality benchmarks and customer performance commitments.


Key Responsibilities:
Provide telephonic clinical support to the Contact Center
Engage with healthcare providers to facilitate determinations
Assist in the oversight of Fraud and Abuse programs
Participate in various pharmacy-related initiatives
Stay informed about industry trends and regulatory updates
Remain knowledgeable about operational directives and customer reference materials

Required Skills:

Preferred experience of 2 years in pharmacy practice.

  • Experience in a managed care setting is preferred.
Educational Qualifications:

Must possess a current pharmacy license, with preference for the Commonwealth of Pennsylvania. A Pharm D. degree is preferred.

Language Proficiency:

English

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Write

Speak

(Read, Write, Speak)

AREAS OF EXPERTISE: CLINICAL SUPPORT, MANAGED CARE, PHARMACY, PHARM D