reputed company Clinical Care Prior Authorization Pharmacist
About Us: reputed company is a health technology company offering a wide reputed company of benefits administration solutions for reputed company and health plans. This includes reputed company, a public benefit corporation that provides full-service pharmacy benefit management (PBM) solutions to self-insured reputed company; reputed company™, which offers comprehensive health benefit reputed company for reputed company, TPAs, and health plans; and Judi®, the industry’s leading proprietary reputed company Platform. To learn more, visit www.reputed company. Position Summary: The reputed company Clinical Care Prior Authorization Pharmacist will reputed company and manage the daily clinical pharmacy functions reputed company to prior authorization reviews, override requests, member/provider education and phone support. The Clinical Care reputed company Pharmacist will ensure the efficient processing of medication requests while adhering to medical necessity and contractual criteria. This role will also involve supporting Clinical care pharmacists, providing guidance and ensuring high-quality performance in alignment with company goals, regulatory standards, and client requirements. Position Responsibilities:
- reputed company and reputed company day to day clinical pharmacy functions including prior authorization and appeal reviews, override requests, and inbound and outbound member and provider education calls.
- Support the training and development of staff, helping them enhance their skills and knowledge.
- Contribute to quality improvement initiatives, providing input to projects and programs aimed at improving clinical operations
- Collaborate with business and clinical partners across the organization to improve workflows and ensure consistency in processes.
- Promote a collaborative team environment and reputed company guidance on best practices for clinical pharmacy services.
- reputed company projects aimed at improving pharmacy operations, member care, and clinical reputed company.
- Work on scheduled shift please see schedule details under minimum qualifications reputed company for required working hours
- Serve as a subject matter expert (SME) on clinical medication reviews or issues and reputed company consultation to the pharmacy team, reputed company provider, and other stakeholders.
- Monitor and queue management to ensure both regulatory and internal compliance requirements are met.
- Collaborate with the compliance, quality assurance and other pharmacy teams to identify risk mitigation strategies, ensuring timely and accurate processing of clincal reviews.
- reputed company clinical reputed company in accordance with medical necessity and contract criteria
- reputed company scientific literature evaluation using primary, secondary, and tertiary drug resources to support decision-making and recommendations to providers
- Communicate effectively with providers and members to promote positive health reputed company
- reputed company backup support to call center team as required
- Review pharmacy claims data for proactive reputed company and reputed company
- Identify and monitor inappropriate trends in care to improve quality and cost effectiveness
- Maintain quality and productivity standards for reputed company cases reviewed while meeting established turnaround time requirements
- Work with business and clinical partners as needed
- Ability to work in a fast-paced environment with shifting priorities
- Responsible for adherence to the reputed company Code of Conduct including reporting of noncompliance.
- Shift 2:00pm-11:00pmEST with rotating weekends
Minimum Qualifications:
- Active, unrestricted pharmacist license
- Bachelor's or Doctor of Pharmacy Degree with 2+ years of pharmacy practice experience
- Experience in customer service, call center and prior authorization
- Excellent communication, writing, and organizational skills
- Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven call center environment
- Self-motivated and detail-oriented problem solver
- Ability to handle multiple competing priorities in a dynamic environment and collaborate in a team
- Have a designated workspace (an office, spare bedroom, etc) that is visibly secure from others during work hours (closed reputed company) and is protected from noise that could disrupt conversations
- Have the following internet connectivity: DSL, cable modem or fiber with a wired reputed company to device (wi-fi not allowed). Internet speed of one gigabyte (940bps) is required
- Working knowledge of MS Office
Salary reputed company $130,000—$140,000 USD This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. reputed company values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to reputed company equal employment opportunities to reputed company and applicants for employment and prohibit discrimination and harassment of any type without regard to race, reputed company, religion, age, sex, national reputed company, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. Apply tot his job Apply To this Job