Offer summary

Qualifications:

Bachelor’s degree in pharmacy or PharmD required., Minimum 2 years’ experience in prior authorizations in a clinical setting., Strong organizational skills and attention to detail are essential., Excellent communication skills, both oral and written, are necessary. .

Key responsabilities:

Evaluate and review prior authorization requests and make coverage determinations.

Verify insurance coverage and eligibility while consulting with healthcare providers.

Communicate decisions regarding cases to healthcare providers and patients efficiently.

Collaborate with team members to process referrals and answer clinical inquiries.

Job description

Our client is looking for multiple Pharmacists with prior authorization experience. This is a remote position so you must have a secure and quite place to work without interruptions.

Responsibilities

Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design.
- Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols.
One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval & denial management processes.
Collaborate with the technicians and prior authorization team members to process referrals, including answering clinical questions and 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.
Performs and handles in bound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations.
Maintain professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered within the Commercial Prior Authorization and Case Review Unit (CRU) line of business.
Perform other related projects and duties as assigned, including attending training sessions and development meetings, and providing on-call and after-hours pharmacist availability as needed.

Requirements

Demonstrated experience using clinical resources, e g., Micromedex, Lexicomp, Clinical Pharmacology
Ability to prioritize, quickly assess, manage multiple tasks and adapt to constantly changing situations.
Prior authorization, call center and/or clinical pharmacy experience.
Excellent organizational skills. Strong detail orientation.
Strong Microsoft Office skills.
Excellent oral and written communication skills and interpersonal skills.
Ability to work independently and make clinical decisions.
Ability to receive phone calls from prior authorization pharmacy technicians and/or providers for clinical information.
Minimum 2 years’ recent experience reviewing and processing prior authorizations against health plan criteria for a determination in a specialty/skilled clinical setting i.e., specialty medical office or Pharmacy Benefits Manager (PBM)
Bachelor’s degree in pharmacy or PharmD

Why Should You Apply?

Health Benefits
Referral Program
Excellent growth and advancement opportunities

As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or express, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.

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