Clinical Pharmacist - Prior Authorization

About the role

This position is for a Clinical Pharmacist working in the Prior Authorization team. Collaborates with the technicians and prior authorization team members to process referrals, including answering clinical questions and collecting appropriate clinical/medical data needed to perform clinical assessments and reviews as per the health plan/employer-agreed criteria within the designated service level agreements. Evaluates and reviews all prior authorization requests and renders coverage determinations based on clinical criteria and plan design, including verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols.

Responsibilities

• Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design.
• Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design.
• Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design.
• Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design.
• Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design.
• Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design.
• Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design.
• Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design.
• Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design.
• Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design.

Requirements

• Active, unrestricted pharmacist licensure
• Current pharmacist experience within Caremark PA Ops required
• Ability and willingness to work a flexible hourly schedule to include overtime, weekends, and holidays as needed

Qualifications

• Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable
• Keyboard skills essential
• Maintain confidentiality of PHI (Protected Healthcare Information)

Skills

• Problem solving ability
• Attention to detail
• Adaptability
• Teamwork
• Communication skills

Benefits

• Medical
• Dental
• Vision
• Paid time off
• Retail Savings Options
• Wellness Programs
• Short-Term Incentive Program