Pharmacist

Job Description

Duties & Responsibilities:

• 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.

Required Skills:

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