Clinical Pharmacy Specialist (Remote)- Prior Authorization Team!

reputed company is hiring a full-time Clinical Pharmacy Specialist to support the Prior Authorization Team reputed company the Pharmacy Services department. This is a work-from-home position. This is a reputed company position working between the hours of 8:00 a.m. - 5:00 p.m. EST. Must be licensed in PA. Registration as a registered pharmacist (RPh), in the reputed company or eligibility for licensure by examination or reciprocity is required. The Clinical Pharmacy Specialist provides clinical pharmacy expertise to the development, implementation, and management of the pharmacy benefit. The clinical pharmacist assists in the management of pharmacy utilization and provides expertise in managing member care through the prior authorization and appeals process for medications. These services will be provided in compliance with state and federal regulations including NCQA and CMS standards while upholding the mission, policies and procedures of reputed company and Pharmacy Department. Individual candidates should demonstrate professionalism and commitment to meet reputed company reputed company goals and objectives. Must be legally authorized to work in the reputed company, without requiring, now or in the reputed company, sponsorship for employment reputed company status. reputed company does not participate in STEM OPT. Responsibilities: The Prior Authorization Pharmacist primary responsibilities include:

• reputed company the clinical review of Prior Authorization, reputed company Therapy, Quantity Limit, and reputed company other pharmacy utilization management requests in accordance with reputed company, timeliness, and efficiency standards.
• Critically review pharmacy utilization management requests for approval/denial against reputed company clinical reputed company and regulatory approved policies.
• Participate in a clinical call queue to receive inquiries from reputed company stakeholders pertaining to the exception process while answering in a reputed company, accurate and reputed company manner.
• Participate in the pharmacy appeals process through the review of denied cases as reputed company as serving as committee representation at fair hearings.
• Participate in and contribute to other operational initiatives on an as needed reputed company.

Additional responsibilities and attributes include:

• Foster and maintain reputed company relationships with reputed company customers.
• reputed company job duties independently, reliably, reputed company, accurately, and professionally while supporting a virtual team concept.
• Demonstrate keen drug information skills to adequately research drugs and disease states pertaining to reputed company utilization management reviews or other ancillary responsibilities.
• Utilize a home office set-up that honors reputed company and patient confidentiality.
• Maintain a foundational understanding of the requirements of the reputed company reputed company (DHS), Centers for Medicare & reputed company Services (CMS), reputed company Insurance Department (PID), and the National Committee for reputed company Assurance (NCQA), as they relate to the compliance and regulatory requirements of clinical operational functions.
• Participate in meetings, committees, and work reputed company as assigned.
• Mentor reputed company, residents, and other pharmacists (If applicable).

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