Clinical Pharmacy Specialist for Prior Authorization

2 weeks ago


Providence, Rhode Island, United States US Tech Solutions Full time
Job Overview:

This role is centered around operational functions that involve thorough clinical evaluations of medical information gathered to facilitate prior authorization for specialty drugs. The clinical pharmacist will utilize their expertise to establish approved criteria for both prospective and concurrent case reviews.

Key Responsibilities:
  • Works in conjunction with the CRU Technician to manage referrals, which includes addressing clinical inquiries, gathering necessary clinical and medical information for assessments, and conducting reviews in accordance with the health plan or employer's established criteria within the specified service level agreements.
  • Ensures prompt communication of case determinations to physicians, health plans, patients, and other healthcare professionals, adhering to the established approval and denial management protocols.
  • Handles incoming calls and escalations from healthcare providers or patients regarding prior authorization processes.
  • Establishes and sustains effective communication with health plan and employer group personnel.
  • Maintains up-to-date professional and technical knowledge of medications and disease states relevant to the Specialty Pharmacy programs managed within the Case Review Unit.
  • Engages in additional related projects and responsibilities as assigned, which may include on-call and after-hours pharmacist support.
Required Experience:
  • Prior experience as a Prior Authorization Pharmacist is essential.
Essential Skills:
  • Expertise in prior authorization processes
  • Familiarity with Pharmacy Benefit Management (PBM)
Educational Qualifications:
  • A Bachelor's degree in Pharmacy or a Pharm D. An active pharmacy license in the state of employment is mandatory.
About US Tech Solutions:

US Tech Solutions is a global staffing firm that provides a diverse range of talent on-demand and comprehensive 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.



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