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

Skills:

Required

• Prior Authorization
• Medical Necessity
• Benefit Decisions
• Pharmacy Guidelines
• Prior Authorization Criteria

Additional

• Industry Regulations
• Clinical Judgment
• Clinical Support
• Fraud and Abuse Program Oversight
• PC Skills
• Windows Based Environment
• Prior Authorization Experience
• Coverage Determination Experience

Minimum Degree Required:

• Bachelor's Degree

Notes:

Candidates must hold an active pharmacist license in good standing in any of the 50 U.S. states.