Clinical Pharmacist - Prior Authorizations (PST / MST only!)
Insight GlobalUnited States11 hours ago
Job type
- Full-time
Job descriptionReview prior authorization requests Support the Prior Authorization Coordinators processing of PA cases Provide clinical services to patients per their plan(s) benefits Research and provide documentation to support prior authorization decisions Develop and maintain documentation that supports PBM programs Interface with physicians, pharmacists, and specialty pharmacy providers Some days will be scheduled to only review cases and others days will be assigned to helping with inbound calls. Responsible for providing clinical review support services to client plan(s) contracting for clinical services. This includes reviewing prior authorization requests and either deciding to approve or deny the request. Support services also include, but not limited to, clinical review, analysis, recommendation, decision and documentation of prior authorization requests, medical exception requests, and requests as required by client contracts and Utilization Management delegation agreements. Review medication request guidelines for clinical appropriateness and operational efficiency. Assist in the revision and creation of new or existing medication request guidelines as indicated. May consult regarding a PA request directly with a client representative or an internal Subject Matter Expert or contact a dispensing pharmacist, prescriber, or prescriber representative to obtain additional information. Provide drug information support. The position may also need to follow general guidance from the client on the handling of specific request types (non-formulary, quantity exceptions, etc.) Research and provide clinical literature documentation to support prior authorization decisions as indicated. Coordinate and assist in the preparation of utilization and compliance reporting for client plans. Ensure timely preparation and review of plan data and client presentations, when required. Coordinate and assist with projects associated with prior authorization program development, implementation, and internal and external communications. Provide feedback to Prior Authorization Coordinators (PACs) regarding the processing of PA cases referred for clinical review. This includes PAs that do not follow proper protocol of initial reviews before sending to the Clinical Specialists. Provide in-service education to PACs regarding topics such as PA guidelines, diagnoses commonly seen as part of the PA review process.
Position : Clinical Pharmacist - Prior Authorization
Location : REMOTE but must live in PST / MST time zone
Requirements :
- Pharmacy degree (Pharm. D.)
- Current, unrestricted Registered Pharmacist license in the United States
- 2+ years of prior authorizations experience for a PBM
Quick Overview :
Detailed Overview :
Compensation : up to $61.75 / hr.
Exact compensation may vary based on several factors, including skills, experience, and education. Employees in this role will enjoy a comprehensive benefits package starting on day one of employment, including options for medical, dental, and vision insurance. Eligibility to enroll in the 401(k) retirement plan begins after 90 days of employment. Additionally, employees in this role will have access to paid sick leave and other paid time off benefits as required under the applicable law of the worksite location.
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Clinical Pharmacist • United States
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