Registered Pharmacist

Job Description

Job Summary:

• As a licensed healthcare professional employed in the Prior Authorization Department the primary responsibility of Pharmacist (R) is to make determinations on prior authorization requests for coverage of pharmaceutical products.
• Determinations include medical necessity and benefit decisions.
• Decisions are made in accordance with established pharmacy guidelines, prior authorization criteria, industry regulations and sound clinical judgment.
• Prior Authorization Pharmacist (R) works independently with respect to reviews and decision making, with the support of Pharmacist II (R)s and supervisors. Pharmacist (R) works as a member of a team of peers committed to meeting or exceeding quality standards and customer performance guarantees.
• This position includes a rotating weekend schedule if business needs dictate.

Additional responsibilities include:

• Provide clinical support to the Perform Rx Customer Care Center.
• Engage providers in discussions to support determinations.
• Support Fraud and Abuse program oversight.
• Keep abreast of industry trends and regulatory changes.
• Keep abreast of operational directives and customer reference materials.

Qualifications:

• Bachelor’s Degree, PharmD preferred.
• Current Pharmacist license.
• No experience required, Prior Authorization or Coverage Determination experience preferred.
• Proficient PC skills in a Windows based environment.