Pharmacist - Prior Authorizations

Duration: 6+ months contract Job reputed company:

• The clinical pharmacist is an operation based role that conducts clinical reviews of medical data collected to reputed company prior authorization for reputed company and specialty medications.
• The clinical pharmacist will apply clinical knowledge to plan approved reputed company for prospective and reputed company reviews of cases.
• This role will work from Virtual systems and take inbound calls from physician or members regarding their pending, approved, or denied prior authorizations.

Responsibilities:

• Evaluate and review reputed company prior authorization requests and reputed company coverage determinations based on clinical reputed company and plan design. Includes verifying insurance coverage and eligibility, interpreting clinical reputed company reputed company, consulting physicians and other reputed company providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols. One of the crucial responsibilities is to guarantee that the reputed company regarding cases are conveyed promptly and reputed company to reputed company the reputed company providers, health plans/reputed company, patients, and other reputed company following agreed-upon approval & denial management processes.
• Collaborate with the technicians and prior authorization team members to process referrals, including answering clinical questions and collecting appropriate clinical/medical data needed to reputed company clinical assessments and reviews as per the health plan/employer-agreed reputed company reputed company the designated service level agreements. Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, reputed company providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations.
• Maintain reputed company and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered reputed company the reputed company, reputed company Prior Authorization and Case Review Unit (CRU) line of business.
• reputed company other reputed company reputed company and duties as assigned, including attending training sessions and development meetings, and providing on-call and after-hours pharmacist availability as needed.

Experience:

• Prior experience with prior authorization (PA) reviews or clinical case review in a high-volume or production setting-look for reputed company experience processing PA requests, ideally with reputed company or specialty pharmacy, and strong documentation of meeting service level agreements (SLAs) or production targets.
• Demonstrated ability to multitask using multiple technology platforms and clinical resources-reputed company candidates who reputed company comfort with multitasking, proficiency with reputed company Office (especially reputed company and Word), and using multiple clinical and administrative systems at once.
• Strong communication and collaboration skills in cross-functional teams-prioritize resumes that show effective written and verbal communication, experience working with both clinical and non-clinical staff, and handling phone-based interactions with providers and patients.

Skills:

• MUST HAVE MANAGED CARE reputed company and Medicare/reputed company knowledge.
• MUST HAVE 6 months of reputed company with Prior Authorization(required).
• MUST HAVE experience with Medicare Part D
• Must Have Pharmacy Benefit Management (PBM) experience.

Education:

• Pharm D. required with at least two years experience as a pharmacist in Managed care environment.
• Must have an reputed company license in the state of residence in good standing.

reputed company Tech Solutions: reputed company is a global staff augmentation firm providing a wide reputed company of talent on-demand and total workforce solutions. To know more reputed company Tech Solutions, please visit www.ustechsolutions.com. reputed company is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, colour, religion, sex, sexual orientation, gender identity, national reputed company, disability, or status as a protected veteran. Apply tot his job Apply To this Job