Job Overview
We are seeking a dedicated and knowledgeable PBM Prior Authorization Pharmacist to join our dynamic team in a fully remote capacity. In this pivotal role, you will leverage your clinical expertise to conduct thorough reviews of medical data for prior authorization processes concerning specialty medications. This position offers an opportunity to contribute meaningfully to patient care while working within an esteemed organization.
Key Responsibilities
- Conduct clinical evaluations of medical information to facilitate prior authorizations for specialty drugs.
- Utilize your clinical insights to apply and strategize approved criteria for both prospective and concurrent case reviews.
- Manage and respond to incoming calls related to pending prior authorizations from both healthcare providers and patients.
- Collaborate effectively with the Clinical Review Unit (CRU) Technician to process referrals and address clinical inquiries, ensuring comprehensive data collection for informed assessments.
- Promptly communicate case outcomes to physicians, health plans, employers, patients, and other relevant healthcare professionals while adhering to established approval and denial protocols.
- Address escalations and inquiries from healthcare providers or patients regarding prior authorization processes.
- Stay abreast of developments in pharmacology and related disease states pertinent to the Specialty Pharmacy programs managed within the Case Review Unit.
Required Skills
- Strong clinical knowledge related to pharmacology and medication management.
- Excellent communication abilities for effective interaction with healthcare professionals.
- Proficient in assessing and interpreting complex medical data.
- Capable of managing prior authorization processes within a pharmacy benefit management (PBM) environment.
Qualifications
- A minimum of 1 year of recent experience specifically in PBM prior authorization.
- A valid and active Pharmacist license in your residing state is required.
- Mandatory attendance during the initial 90 days of employment.
Career Growth Opportunities
This contract position holds the potential for permanent employment based on attendance, performance, and business requirements. Our organization is committed to providing professional development avenues that will support your career advancement within the healthcare sector.
Compensation And Benefits
We offer a competitive benefits package for full-time employees after 90 days of service, which includes health, vision, dental, life, and short-term disability insurance. Additionally, after one year of employment, you will become eligible for our 401(k) retirement plan with a company match.
Employment Type: Full-Time
