Pharmacy Authorization Specialist

1 week ago


Philadelphia, Pennsylvania, United States vTech Solution Full time

Position Overview:

As a licensed healthcare professional within the Pharmacy Prior Authorization Department, your main role is to evaluate and decide on prior authorization and coverage requests for pharmaceutical products.

These evaluations encompass assessments of medical necessity and benefit determinations, adhering to established pharmacy protocols, contractual criteria, industry regulations, and sound clinical judgment.

The Prior Authorization pharmacist operates autonomously in reviews and decision-making, while receiving support from senior pharmacist staff and supervisors.

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


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

Required Skills:

Preferred 2 years of pharmacy experience.

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

Current pharmacy license, preferably in the Commonwealth of Pennsylvania. Pharm D. is preferred.

Language Proficiency:

English

Read

Write

Speak

(Read, Write, Speak)

Core Competencies:
CLINICAL SUPPORT, MANAGED CARE, PHARMACY, PHARM D.

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