Job Description

Job Description

Job Description

Job Title: Remote PBM Prior Authorization Pharmacist

Pay: $53 an hr | Bi-weekly

Job Type: Remote

Shift Options:

• Shifts available (Sun-Thurs or Tues-Sat):
  10:30am-7pm CST
  11am-7:30pm CST
  11:30am-8pm CST

Remote PBM Prior Authorization Pharmacist Overview:

• Responsibilities:
  1.) Evaluate and review all prior authorization requests and render 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 efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval & denial management processes. (60%)
  2.) 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. 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. (25%)
  3.) Maintains professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered within the Commercial Prior Authorization and Case Review Unit (CRU) line of business. (10%)
  4.) Performs other related projects and duties as assigned, including attending training sessions and development meetings, and providing on-call and after-hours pharmacist availability as needed. (5%)

  Essential Functions:
  1. Regular and predictable attendance
  2. Colleague will be required to work mandatory overtime/extended work week when needed
  3. Colleague will be required to travel when needed
  4. Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers.
  5. Adhere to all policies and procedures
  6. Attend on going training and development meetings
  Physical Requirements:
  1. Sits at desk for long periods of time (up to 100%)
  2. Talking on phone for extended periods of time (up to 100%)
  3. Computer use for extended periods of time (100%)
  4. Reading a computer screen (up to 100%)
  5. Light lifting of less than 10 lbs

Remote PBM Prior Authorization Pharmacist Qualifications:

• Prior Work Experience:
  Required: 1 to 3 years
  Preferred: 3 to 5 years

  Required Skills & Other Minimum Required Qualifications:
  Licensed Registered Pharmacist
  Previous pharmacy experience ***in PBM or Prior Authorization*** required.
  Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable. Keyboard skills essential.
  Must be able to multitask and utilize multiple system applications simultaneously.
  Must be able to utilize available resources independently and provide high quality work.
  Must demonstrate problem solving ability and attention to detail.
  Ability to adapt and change with workflow and shifting priorities.
  Ability to work effectively in a team environment and provide mentorship to non-clinical staff on the PA team.
  Must possess excellent written, verbal, grammar, and listening communication skills.
  Must be able to effectively communicate with a diverse customer base (internal and external) in a friendly and confident manner.
  Ability to maintain confidentiality of PHI (Protected Healthcare Information).

Remote PBM Prior Authorization Pharmacist Benefits:

• Benefits are available to full-time employees after 90 days of employment and include health, optical, dental, life, and short-term disability insurance.
• A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates.

How to Apply:

If you are interested in this position, please apply OR submit your resume to:

Saw Hlaing | shlaing@alinestaffing.com | 412-790-5425

Job Tags

Similar Jobs