Prior Authorization Pharmacist

Description

Who We Are - Motivated by Purpose. Powered by Clinical Expertise.

Founded in 1983, we’re a clinically-driven, tech-enabled utilization management company offering expert clinical reviews, regulatory guidance, and actionable insights to healthcare organizations.

Excellence starts with our people.

WE OFFER

• A competitive compensation package.
• Benefits include healthcare, vision and dental insurance, a generous 401k match, paid vacation, personal time, and holidays.
• Growth and training opportunities.
• An award-winning remote work environment

POSITION OVERVIEW



The PA Pharmacist is an important member of the pharmacy department. The PA Pharmacist works alongside the Supervisor, PA Pharmacists to set and meet production goals and to ensure each prior authorization is completed on time and in accordance with the individual client’s prior authorization criteria. The PA Pharmacists also serve as a drug information resource for MRIoA physicians and reviewers.

Roles:

• To evaluate prior authorizations for drug appropriateness per drug policy criteria
• To provide cost-effective, rational drug therapy and disease state management
• To provide excellent customer service to health plan clients, practitioners, and members
• To serve as an educational resource regarding drug and clinical information for all internal and external customers

Primary Responsibilities or Assigned Duties:

• Perform case reviews for prior authorizations
• Complete Peer-to-Peer reviews with healthcare professionals regarding the outcomes of prior authorizations
• Serve as an active member of client committees, as requested
• Monitor prescription turnaround time so that internal standards and client performance guarantees are met
• Serve as a resource for team members for clinical and drug information
• Assist in implementing programs and process improvements to enhance the level of internal and external customer service provided
• Provide a high-quality review of requested medication with clear notes of determination
• Communicate with team and Supervisor, PA Pharmacist as appropriate to proactively inform of issues or concern
• Recognize and recommend operational improvements
• Other special projects and tasks as assigned

Requirements

Skills and Experience:

• Possess a strong drug knowledge and able to clinically evaluate all drug authorization requests correctly
• Ability to work in a fast-paced and high-functioning environment and meet deadlines while managing multiple high priorities
• Personal computer literacy and high competency in use of Microsoft Word and Excel
• Strong organizational skills with attention to details
• Strong oral and written communication skills
• Well-developed training skills
• Strong working knowledge of medical insurance terminology and processes
• Excellent critical thinking capabilities with a strong attention to detail
• Exceptional customer service skills
• Minimum two years of experience as a pharmacist preferred
• Pharmacy Benefit Management experience preferred
• Credentialed and privileged by the company's credentialing committee
• Willingness to obtain additional state licensure as required for the position

Education:

• PharmD
• Pharmacist license in good standing

Work Environment:

Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required. This role is designed to be a remote position (work-from-home).

Diversity Statement:

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.



Drug-Free Workplace:

This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment. Employees are required to adhere to all applicable HIPAA regulations and company policies and procedures regarding the confidentiality, privacy, and security of sensitive health information.

California Consumer Privacy Act (CCPA) Information (California Residents Only):

• Sensitive Personal Info: MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver’s license number, or state identification card number, and passport number.
• Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please email the Medical Review Institute at .

Originally posted on Himalayas