Duties:
As a licensed healthcare professional employed in the Prior Authorization Department the primary responsibility of Pharmacist (R) is to make determinations on prior authorization requests for coverage of pharmaceutical products. Determinations include medical necessity and benefit decisions. Decisions are made in accordance with established pharmacy guidelines, prior authorization criteria, industry regulations and sound clinical judgment.

Prior Authorization Pharmacist (R) works independently with respect to reviews and decision making, with the support of Pharmacist II (R)s and supervisors. Pharmacist (R) works as a member of a team of peers committed to meeting or exceeding quality standards and customer performance guarantees. This position includes a rotating weekend schedule if business needs dictate.

Additional responsibilities include:
Provide clinical support to the PerformRx Customer Care Center
Engage providers in discussions to support determinations
Support Fraud and Abuse program oversight
Keep abreast of industry trends and regulatory changes
Keep abreast of operational directives and customer reference materials

Skills:
No experience required, Prior Authorization or Coverage Determination experience preferred
Proficient PC skills in a Windows based environment

Education:
Bachelor’s Degree, PharmD preferred
Current Pharmacist license

Certifications & Licenses:
Pharmacist license

Skills:
Required

PRIOR AUTHORIZATIONMEDICAL NECESSITYBENEFIT DECISIONSPHARMACY GUIDELINESPRIOR AUTHORIZATION CRITERIA

Additional
COVERAGE DETERMINATION EXPERIENCEFRAUD AND ABUSE PROGRAM OVERSIGHTPC SKILLSINDUSTRY REGULATIONSCLINICAL JUDGMENTWINDOWS BASED ENVIRONMENTPRIOR AUTHORIZATION EXPERIENCE

Notes:

This will be a remote position, the work schedule will be Monday through Friday, 10:00 AM to 6:30 PM EST. Please note that the shift schedule may also be adjusted in the future to meet operational demands.
Remote - EST