Prior Authorization Pharmacist Advisor

A-Line Staffing is now hiring a Remote Prior Authorization Pharmacist ! This role offers an opportunity to work for a Fortune 500 company with career growth potential in a fully remote capacity.

Highlights

• Pay: $53.00 per hour
• Hours: 7:00 AM – 8:00 PM EST Monday – Friday, 7:00 AM – 4:30 PM EST Saturday and Sunday (set rotation)
• Location: Remote / Work from Home (must have dedicated, quiet workspace)
• Type: Full-time, contract
• Training: First 8 weeks M-F, 9:00 AM – 5:30 PM EST (attendance mandatory)

Responsibilities

• Support Medicare Part D members and providers with pharmacy benefit and prior authorization requests.
• Ensure accurate case setup and complete clinical review of prior authorization and Medicare appeals in compliance with CMS guidelines.
• Review clinical information and make appropriate determinations based on drug compendia and clinical judgment.
• Conduct provider outreach for additional clinical clarification when necessary.
• Accurately document all prior authorization and Medicare Part D requests and maintain compliance with CMS-mandated timelines.
• Meet or exceed departmental productivity and quality standards.

Requirements

• Bachelor’s Degree in Pharmacy or Doctor of Pharmacy (PharmD) required.
• Active pharmacist license in the state of residence (must provide proof).
• Strong attention to detail and ability to work independently in a remote environment.
• Proven ability to apply clinical judgment and interpret drug compendia resources.
• Prior experience in Medicare Part D, prior authorizations, or pharmacy benefit management preferred.
• Computer literate with knowledge of Excel, Word, and preferably Access, PowerPoint, and Visio.
• Must provide internet speed test (minimum 25 Mbps download / 5 Mbps upload) and have a dedicated, quiet workspace.

Benefits

• Benefits available to full-time employees after 90 days.
• 401(k) with company match available after 1 year of service on eligibility dates.

• Perform basic nursing care and treatments
• Teach the nurse delegation for nursing assistant classes
• Assisting in analyzing medical records
• Review medical records to analyze treatments verses standards of care/ medical necessity
• Provide clinical support to assigned skilled nursing centers
• Analyze and summarize medical records
• Analyze medical portions of legal documents
• Enhance the quality of patient care by providing consultation to care providers and nurse educators
• Reviewing medical records and preparing chronologies
• Identify applicable standards of care in medical malpractice cases
• Work closely with all nursing staff as a clinical preceptor to provide and evaluate hands on patient care
• Organize, review and summarize medical records to determine compliance with standard of care
• Organize, review and summarize medical records to determine compliance with standards of care
• Facilitate education and orientation of the nursing staff
• Document clinical workflow in the various care area departments
• Cultivate nursing leadership support network
• Foster nursing leadership support network
• Ensure the practice of nursing
• Serve as a clinical resource for patient care staff throughout the hospital
• Transitioning nursing facilities to pharmacy's services