Pharmacist (R)

Duties:

• As a licensed healthcare professional employed in the Prior Authorization Department, the primary responsibility 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.
• Works independently with respect to reviews and decision-making, with the support of Pharmacist II (R)s and supervisors.
• 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 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.