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Prior Authorization Pharmacist -26-16615

US Tech Solutions, Inc.

Remote, RI(remote)

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JOB DETAILS
SKILLS
Artificial Intelligence (AI), Biotech and Pharmaceutical, Clinical Assessment, Clinical Data, Clinical Data Collection, Clinical Medicine, Clinical Validation, Disease, Health Plan, Healthcare, Managed Care, Medications, Nursing, On Call, Patient Care Authorizations, Patient Care Denials, Pharmacy, Service Level Agreement (SLA), Systems Administration/Management, Time Management
LOCATION
Remote, RI
POSTED
3 days ago
Duration: 6+ months contract
 
Job Description:
  • The clinical pharmacist is an operation based role that conducts clinical reviews of medical data collected to perform prior authorization for specialty medications.
  • The clinical pharmacist will apply clinical knowledge to plan approved criteria for prospective and concurrent reviews of cases.
  • This role will work from Pharmacy supported systems and take inbound calls from physician or members regarding their pending, approved, or denied prior authorizations
 Responsibilities:
  • Collaborates with the Technicians and Nurses to process authorization requests, including answering clinical questions, 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. (20%)
  • Coordinates timely communication of case decision to physician, health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes. (15%)
  • Handles inbound phone calls and escalations from physicians or patients regarding Prior Authorization (50%)
  • Establishes and maintains communication among  health plan and employer group staff. (5%)
  • Maintain professional and technical knowledge of drug and disease-states for the Specialty Medical programs administered within the Novologix. (5%)
  • Performs other related projects and duties as assigned including on call and after hours pharmacist availability could be required. (5%)
 Skills:
  • Prior Authorization
  • PBM
 Experience:
  • Minimum of 2-5 years of clinical experience with or clinical review of prior authorization requests is preferred.
  • Experience using MS Office and other Windows based computer applications, strong organizational skills, interpersonal skills, and detail orientation are important for this position
 Education:
  • Pharm D. required with at least two years experience as a pharmacist in Managed care environment.
  • Must have an active license in the state of residence in good standing.
 
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com.
 
US Tech Solutions is an Equal Opportunity Employer.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity,
national origin, disability, or status as a protected veteran.
 
By applying, you acknowledge that AI-assisted tools may be used during hiring.

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About the Company

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US Tech Solutions, Inc.