Clinical Pharmacist Advisor

2 weeks ago

Providence, RI, United States US Tech Solutions Full time

Job Description:

  • As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. You will be responsible for ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to providers for more information when needed, and ensuring accurate decisions that comply with compendia and Medicare guidance and timelines. This is a great opportunity to initiate a career with a leading healthcare company by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience.

Responsibilities:

  • Collaborates with multiple groups within CD&A, including answering clinical questions, collecting appropriate clinical/ medical data needed to perform clinical assessments, and reviews as per the health plan/employer agreed criteria within the designated service level agreements. (20%)

  • Coordinates timely communication of case decision to physician, health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes. (20%)

  • Reviews cases in progress and provides a Clinical decision regarding Prior Authorizations, Tier Exceptions and Non-Formulary requests (50%)

    1. Performs other related projects and duties as assigned including on call and after-hours pharmacist availability could be required. (10%)

Experience:

  • Minimum 1 year of experience in Prior Authorization & Medicare Part D although 2-5 years is preferred

Skills:

  • Prior Authorization

  • Medicare Part D

Education:

  • Bachelor's Degree Required, Pharm D 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. To know more about US Tech Solutions, please visit www.ustechsolutions.com (http://www.ustechsolutionsinc.com) .

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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