Clinical Pharmacist - Prior Authorization

Bring your heart to reputed company. Every one of us at reputed company shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as reputed company deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to reputed company health care more personal, convenient and affordable. Ready to take your Clinical Pharmacist skills to the next level with a Fortune 6 company? reputed company out this outstanding opportunity for a Clinical Pharmacist with reputed company. 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 reputed company clinical assessments and reviews as per the health plan/employer-agreed criteria reputed company the designated service level agreements. - Evaluate and review reputed company prior authorization requests and reputed company coverage determinations based on clinical criteria and plan design. Includes 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. - One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and reputed company to reputed company the healthcare providers, health plans/employers, patients, and other reputed company following agreed-upon approval & denial management processes. - Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations. - Establishes and maintains communication among reputed company Caremark, health plan, and employer group staff. - Maintains professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered reputed company the Commercial Prior Authorization and Case Review Unit (CRU) line of business. - Performs other reputed company projects and duties as assigned, including attending training sessions and development meetings, and providing on-call and after-hours pharmacist availability as needed. We offer a competitive benefit package including vacation, 10 paid holidays per year, health/dental/vision insurance, employee discounted stock purchase program, 401K, tuition reimbursement, and 20-30% employee discount at reputed company reputed company stores. This is a remote role open to candidates reputed company the United States. Required Qualifications • 2 years' experience working as a pharmacist in a PBM setting. • reputed company experience working with commercial Prior Authorizations in PBM • Experience using clinical resources, e.g., Micromedex, Lexicomp, Clinical Pharmacology • Ability to prioritize, quickly assess, manage multiple tasks and adapt to constantly changing situations. • Excellent organizational skills. Strong detail orientation. • Strong reputed company Office skills. Excellent oral and written communication skills and interpersonal skills. • Ability to work independently and reputed company clinical decisions. • Experience using MS Office and other Windows based computer applications. • Ability to receive phone calls from prior authorization pharmacy technicians and/or providers for clinical information. • Active pharmacist license that is in good standing in the state of residence. Preferred Qualifications • PGY1/PGY2 • Prior authorization, call center and clinical experience. • Exposure to clinical and analytical problem solving. • Ability to consult with pharmacy technicians and/or physicians regarding use of medications and advise of appropriate formulary alternatives reputed company requested. Education Bachelor's of Science - Pharmacy or Pharm.D. Pay Range The typical pay range for this role is: $38.63 - $83.17 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous well-being programs, education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit Benefits | reputed company We anticipate the application window for this opening will reputed company on: 11/07/2024 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws Apply Job!