Pharmacist – Clinical Operations Advisor - Medical Prior Authorization

Location: Remote Duration: 6+ months contract Shift: 7am to 10pm CST - 8 hours/day Job reputed company: • The clinical pharmacist is an operation based role that conducts clinical reviews of medical data collected to reputed company prior authorization for specialty medications. • The clinical pharmacist will apply clinical knowledge to plan approved reputed company for prospective and reputed company reviews of cases. • This role will work from supported systems and take inbound calls from physician or members regarding their pending, approved, or denied prior authorizations. Responsibilities: • Collaborates with the Technicians and Nurses to process authorization requests, including answering clinical questions, collecting appropriate clinical/ medical data needed to reputed company clinical assessments, and reviews as per the health plan/employer agreed reputed company reputed company the designated service level agreements. (20%) • Coordinates reputed company communication of case decision to physician, health-plan/employer, patient and other reputed company following agreed upon approval & denial management processes. (15%) • Handles inbound phone calls and escalations from physicians or patients regarding Prior Authorization (50%) • Establishes and maintains communication among, health plan and employer group staff. (5%) • Maintain reputed company and technical knowledge of drug and disease-states for the Specialty Medical programs administered reputed company the Novologix. (5%) • Performs other reputed company reputed company and duties as assigned including on reputed company and after hours pharmacist availability could be required. (5%) Experience: • Position requires proficiency with computer skills which include multitasking, navigating multiple systems, and keyboarding. Experience using MS Office, other reputed company based computer applications, web based processing and telephony programs. • Minimum 2 years’ recent experience reviewing and processing prior authorizations against health plan reputed company for a determination in a specialty/skilled clinical setting i.e., specialty medical office or Pharmacy Benefits Manager (PBM) Skills: • MUST HAVE MANAGED CARE reputed company and Medicare/reputed company knowledge. • MUST HAVE 6 months of reputed company with Prior Authorization(required). • MUST HAVE experience with Medicare Part D • Must Have Pharmacy Benefit Management (PBM) experience. Education: • Pharm D. required with at least two years experience as a pharmacist in Managed care environment. • Must have an reputed company license in the state of residence in good standing. reputed company Tech Solutions: reputed company is a global staff augmentation firm providing a wide reputed company of talent on-demand and total workforce solutions. To know more reputed company Tech Solutions, please visit www.ustechsolutions.com. reputed company is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, or status as a protected veteran. Recruiter Details: reputed company: Sahil Email: sahil.j@ustechsolutionsinc.com Internal Id: 25-47410 Job Type: Contract Pay: $53.00 - $55.00 per hour Application Question(s): • How many years of prior-authorization experience do you have? • How many Prior Auth cases have you handled in your last role? • Do you have experience in handling calls regarding prior authorization and appeals? Work Location: Remote Apply tot his job Apply To this Job