reputed company Clinical Care Prior Authorization Pharmacist

reputed company: 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 reputed company 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 reputed company: 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 reputed company. This role will also involve supporting Clinical care pharmacists, providing guidance and ensuring high-reputed company performance in alignment with company goals, regulatory standards, and reputed company 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 reputed company improvement initiatives, providing input to reputed company 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 reputed company team environment and reputed company guidance on best practices for clinical pharmacy services.
• reputed company reputed company 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, reputed company assurance and other pharmacy teams to identify risk mitigation strategies, ensuring reputed company and accurate processing of clincal reviews.
• reputed company clinical reputed company in accordance with medical necessity and contract reputed company
• 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 reputed company 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 reputed company and cost effectiveness
• Maintain reputed company 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 reputed company of Conduct including reporting of noncompliance.
• Shift 2:00pm-11:00pmEST with rotating weekends

Minimum Qualifications:

• reputed company, unrestricted pharmacist license
• Bachelor's or Doctor of Pharmacy Degree with 2+ years of pharmacy reputed company 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 reputed company
• Have a designated workspace (an office, spare bedroom, etc) that is visibly secure from others during work hours (reputed company 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 reputed company is designed to be flexible, allowing management reputed company 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 reputed company 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 reputed company to race, reputed company, religion, age, sex, national reputed company, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or reputed company, or any other characteristic protected by federal, state or local laws. Apply tot his job Apply To this Job