Case Management, Clinical Support, Medicaid, Medicare, Medications, Patient Care Authorizations, Performance Management, Pharmacy, Policy Implementation, Quality Assurance
Summary:
- Work Mode: 100% Remote
- Duration: 6 months, possibility to extend
- Shift: Mon - Fri 10am – 6:30pm EST, OT possible
Responsibilities:
- Develop clinical criteria for medications, recommend plan design changes, and clinical programs to be initiated.
- Review 140 to 160 clinical prior authorizations or coverage determinations daily.
- Monitor prior authorization requests.
- Provide clinical support to internal departments and address clinical-related questions.
- Ensure appropriate quality controls and initiate opportunities for performance improvement in pharmacy/practice.
- Develop and implement programs designed to impact DUR for both Medicaid and Medicare.
- Develop, implement, and maintain policies and procedures for the pharmacy department.
- Participate in the coordination of the Medicare MTM program.
- Assist case management team with members, including clinical rounds presentations.
Requirements:
- Education/Certification: Required: Bachelors / PharmD
- Licensure: Required: Current states pharmacist license
- Years of experience required: 1 to 3 years experience
Preferred Skills:
- Flexibility to work a weekend rotation
- Top 3 must-have hard skills:
- 1. Clinical decision making
- 2. Ability to learn new skills quickly
- 3. Adaptability
A
Axelon Services Corporation