Pharmacist I, Clinical Prior Authorization
New
Source API remote eligibility restrictions: United States. ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.Full-TimeEntry
Salary101,335 - 126,669 USD per year
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Job Details
- Experience
- Two years’ work experience in a clinical setting, or clinical or managed care pharmacy practice residency preferred
- Required Skills
- Microsoft Office
Requirements
- Bachelor’s degree in Pharmacy or Pharm D.
- Current unrestricted licensure as an RPh.
- Ability to gain reciprocity within 4 months of employment.
- Two years’ work experience in a clinical setting or clinical/managed care pharmacy residency preferred.
- Knowledge of PBM industry, formulary management, pharmacy claims and managed care principles.
- Exceptional clinical skills and judgment.
- Proficiency in drug literature and clinical trial evaluation.
- Proficiency with electronic databases (e.g., Micromedex, Medline).
- Proficiency in MS Word, Excel, and Power Point.
- Complete all annual URAC training requirements.
Responsibilities
- Perform Prior Authorizations.
- Perform duties related to Drug Utilization Review including concurrent, retrospective, and prospective components.
- Support Customer Care with clinical calls requiring pharmacist intervention.
- Interface with physicians, pharmacists, and specialty pharmacy providers regarding benefits and therapeutic interventions.
- Review and evaluate health surveys and utilization data for program management and development.
- Participate in the Coverage Determination process including making all coverage denial determinations.
- Provide input to clinical content of new and existing programs.
- Support operational departments on the implementation of various PBM programs.
- Support clinical expertise related to formulary decisions.
- Review health care survey data for Medicare Part D participants.
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