Pharmacist
Job Description
Job Summary:
- The clinical pharmacist is an operation based role that conducts clinical reviews of medical data collected to perform prior authorization for specialty medications.
- The clinical pharmacist will apply clinical knowledge to plan approved criteria for prospective and concurrent reviews of cases.
- This role will work from Client to Client supported systems and take inbound calls from physician or members regarding their pending, approved, or denied prior authorizations.
Duties and Responsibilities:
- Collaborates with the Technicians and Nurses to process authorization requests, 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. (15%)
- Handles inbound phone calls and escalations from physicians or patients regarding Prior Authorization (50%)
- Establishes and maintains communication among Client, health plan and employer group staff. (5%)
- Maintain professional and technical knowledge of drug and disease-states for the Specialty Medical programs administered within the Client. (5%)
- Performs other related projects and duties as assigned including on call and after hours pharmacist availability could be required. (5%)
Education & Licenses:
- Bachelor’s degree in pharmacy or Pharm D. required with at least two years experience as a pharmacist.
- Must have an active license in good standing.
Skills & Experience:
- 2+ years of clinical experience with specialty medications or clinical review of prior authorization requests.
- Technical & Computer Proficiency.
- Self-Management and Organizational Skills.
- Must have excellent interpersonal skills.
- Clinical Prior Authorization Review Exp.