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Clinical Review Pharmacist
2 months ago
This position is centered around operational responsibilities that involve conducting clinical evaluations of medical information gathered to facilitate prior authorization for specialty pharmaceuticals. The clinical pharmacist will utilize their expertise to establish approved criteria for both prospective and concurrent assessments of cases.
Key Responsibilities:- Works in collaboration with the CRU Technician to manage referrals, which includes addressing clinical inquiries, gathering necessary clinical and medical information for assessments, and reviewing cases according to the agreed criteria set by the health plan or employer within specified service level agreements.
- Ensures prompt communication of case determinations to physicians, health plans, patients, and other healthcare professionals, adhering to established approval and denial management protocols.
- Handles incoming calls and escalations from healthcare providers or patients concerning prior authorization processes.
- Maintains effective communication with health plan and employer group personnel.
- Stays updated on professional and technical knowledge related to medications and disease states relevant to the Specialty Pharmacy programs managed within the Case Review Unit.
- Undertakes additional related projects and responsibilities as assigned, which may include on-call and after-hours pharmacist availability.
- Prior experience as a Prior Authorization Pharmacist is essential.
- Expertise in prior authorization processes
- Knowledge of Pharmacy Benefit Management (PBM)
- A Bachelor's degree in Pharmacy or a Pharm D is required. An active license in the state of employment is mandatory.
US Tech Solutions is a global staffing augmentation firm offering a comprehensive range of talent on-demand and total workforce solutions. For more information about US Tech Solutions, please visit our website.
US Tech Solutions is an Equal Opportunity Employer. All qualified candidates will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
