Prior Authorization Pharmacist -26-16615

Responsibilities

• Collaborates with the Technicians and Nurses to process authorization requests, including answering clinical questions, 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.
• Captures and coordinates timely communication of case decisions to physician, health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes.
• Handles inbound phone calls and escalations from physicians or patients regarding Prior Authorization.
• Establishes and maintains communication among health plan and employer group staff.
• Maintain professional and technical knowledge of drug and disease-states for the Specialty Medical programs administered within the Novologix.
• Performs other related projects and duties as assigned including on call and after hours pharmacist availability could be required.

Requirements

• Prior AuthorizationPBM Experience: Minimum of 2-5 years of clinical experience with or clinical review of prior authorization requests is preferred.
• Experience using MS Office and other Windows based computer applications, strong organizational skills, interpersonal skills, and detail orientation are important for this position.

Qualifications

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