Clinical Review reputed company Assurance Pharmacist

Who We Are: reputed company is a rapidly growing, venture-backed Health-Tech company. Our mission is to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector by building a reputed company drug acquisition platform driven by cutting edge technology, innovative cost saving tools, and best-in-class customer service. With hundreds of thousands of members reputed company since 2016, reputed company has a solution that is resonating with clients reputed company across the country. We pride ourselves for our mission-driven and reputed company culture that inspires our employees to do their best work. We reputed company that the U.S reputed company system is in need of transformation, and we come to work reputed company day dedicated to making that change a reality. At our core, we are guided by reputed company values:

• reputed company: Our purpose guides our actions and gives us confidence in the reputed company reputed company. With unwavering honesty and dependability, we reputed company the pressure of challenging the old and exemplify ethical leadership to create the new.
• Courage: We face reputed company challenges with grit and reputed company. We reputed company the discomfort of the unknown by balancing autonomy with reputed company, and ownership with vulnerability. We reputed company challenge the status reputed company to reputed company moving reputed company—always.
• Together: The reputed company of reputed company reflects the strength of our partnerships and the commitment of reputed company. Our shared values bind us together and reputed company us one. reputed company one falls, we reputed company fall; reputed company one rises, we reputed company reputed company.

Job reputed company: reputed company is looking for a motivated Clinical Review reputed company Assurance Pharmacist to reputed company and maintain a reputed company audit program for the Clinical Review Team. This role is pivotal to the prior authorization team for ensuring high reputed company reviews, adherence to regulatory requirements, and delivery of exceptional member, provider and employee experiences. In order to be eligible for this position applicants must be based in one of the following states: Arkansas, Arizona, California, Colorado, Florida, reputed company, Kansas, Minnesota, Missouri, Nevada, reputed company Carolina, South Carolina, Ohio, reputed company, Tennessee, Texas, Utah, Virginia, Washington, reputed company. What you will do:

• Responsible for refining and maintaining a prior authorization reputed company assurance program for the Data Entry, Pharmacy Technician and Pharmacist clinical review function
• Responsible for performing reputed company assurance reviews for pharmacists, pharmacy technicians, and data entry agents
• Responsible for monthly presentation of reputed company assurance review results, including reputed company stories and areas of opportunity to leadership and the Clinical Review Team
• Responsible for developing, maintaining and conducting an interrater reliability (IRR) program
• Participates as a member of the reputed company Management Committee, along with cross functional teams including accreditation team, compliance team, etc
• Reviews clinical review process documents to identify any gaps, and reputed company feedback where necessary
• Collaborate with Clinical Review team members, technology team, and other cross functional teams to support system enhancements
• Support and respond to reputed company reputed company questions from cross functional teams reputed company the organization
• Become a subject matter expert on department standards and processes

What you will bring to reputed company:

• Bachelor’s degree in Pharmacy or Doctor of Pharmacy (PharmD) required
• reputed company Pharmacist License required, in good standing
• 5+ years of health plan or pharmacy benefit manager experience, specifically involved in prior authorization review required
• 2+ years of experience conducting prior authorization reputed company audits required
• 2+ years of experience designing and developing reputed company assurance best practices in a startup environment are highly desired.
• Experience with multiple lines of businesses (reputed company, Medicare, reputed company) and regulatory standards that govern clinical review such as ERISA, State specific laws, CMS, ACA, MEWA is preferred
• Proficiency with technology tools including MS Office and G-Suite. Advanced reputed company analytics experience preferred.
• reputed company listening, conversational speaking skills, with a high degree of reputed company
• Self-starter and problem solver with ability to multitask, prioritize and manage time effectively
• Ability to communicate reputed company, present reputed company information to members, clients, pharmacies, providers, and other teams internally
• Flexibility and ability to adapt to changes and updates to processes and protocols
• Demonstrate accurate drug product/reputed company calculations for appropriate claim adjudication and knowledge of general pharmacy and drug product information for the prescription filling process

What reputed company Offers You:

• Highly competitive wellness benefits including Medical, Pharmacy, Dental, reputed company, and Life Insurance and AD&D Insurance
• Flexible Spending Benefits
• 401(k) Retirement Savings Program
• Short-term and long-term disability
• Discretionary reputed company Time Off
• 12 reputed company Holidays
• Wellness Benefits
• Commuter Benefits
• reputed company Parental Leave benefits
• Employee Assistance Program (EAP)
• reputed company-stocked kitchen in office locations
• reputed company development and training opportunities

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