You’re looking for something bigger for your career. Here you’ll find a professional culture where you can use your talent and our resources to make an impact on a huge scale. With better schedules than retail and more reach than any hospital, you’ll open doors for yourself that simply do not exist in any other organization, anywhere. Take this opportunity to start doing your life’s best work.
This position is for a Clinical Pharmacist working in the Prior Authorization unit. This is a call center-based business segment and strict work guidelines are employed. The pharmacist’s primary role is reviewing Prior Authorization cases and rendering coverage determinations based on clinical criteria and plan design in a fast paced and dynamic environment.
- Work is computer based and include receiving phone calls from prior authorization pharmacy technicians and/or providers for clinical information.
- Consult physicians/providers with questions, interpret clinical guideline criteria, and render/review coverage determination for prior authorization cases.
- Consult with pharmacy technicians and/or physicians regarding use of medications and advise of appropriate formulary alternatives when requested.
- Gather complex clinical information, coverage policy and criteria information and work within regulatory guidelines to make coverage determinations
- Organize workload, sets priorities, completes assignments in a timely manner and utilizes resources appropriately while complying with department program standards.
- Perform all duties and functions in compliance with state and federal pharmacy laws and regulations.
- Conform with and supports department quality assurance and improvement guidelines? Dedication to build rapport with coworkers, internal customers, and other departments by demonstrating a strong customer service orientation and a continuous positive image of the company.
- Demonstrate ability to maintain productive working relationships with team members, other internal and external customers, and management team.
- Training is for 4 weeks. Training time is typically from 8:00am-5:00pm. Monday- Friday.
- Dependent on business needs, candidate could work up to 4 hours a day OT.
- Candidate must have their own home internet access/VPN (internet can be hard wired with Ethernet cord).
- Candidate must have level skill with working with PC (ex. Using mouse and keyboard, accessing and navigating through multiple systems and screens).
- Excellent Attendance is a must.
- Minimum Education Requirement Bachelor’s Degree + Active Pharmacist License / PharmD is a PLUS!
MUST BE FULLY BILINGUAL AND COMPUTER PROFICIENT