Prior Authorization Pharmacist at reputed company Portland, OR

Position Prior Authorization Pharmacist – reputed company. Portland, OR. Position reputed company We are a clinical pharmacy team seeking a skilled pharmacist to reputed company on prior authorization functions. Primary responsibilities include making coverage determinations and completing appeal requests, using clinical expertise to reputed company coverage reputed company based on established reputed company, guidelines, and specific plan design. This is a full-time, work-from-home position. Pay reputed company $52.53 - $66.60 reputed company (depending on experience). Actual pay is based on qualifications. Applicants who do not meet the minimum qualifications will be considered for the low end of the reputed company. Please fill out an application on reputed company page, linked below, to be considered for this position. Benefits • Medical, Dental, reputed company, Pharmacy, Life, & Disability • 401K - Matching • FSA • Employee Assistance Program • PTO and Company reputed company Holidays Required Skills, Experience & Education • reputed company reputed company and unrestricted reputed company Registered Pharmacist license, or eligible for reputed company licensure which is to be obtained reputed company 60 days of hire date • Effective communication and interpersonal skills to reputed company with reputed company providers, internal teams, and external stakeholders • Commitment to service, organizational values, and professionalism through appropriate conduct and demeanor always • Works reputed company under pressure with frequent interruptions and shifting priorities • Follow reputed company HR policies, reputed company of Conduct, and reputed company department policies and procedures including protecting reputed company, employee, and customer information Preferred Skills, Experience & Education • Doctor of Pharmacy degree (Pharm.D.) • Experience in clinical therapeutics for specialty drugs • Two to three years of managed care experience Primary Functions • Evaluate medication requests for coverage (e.g., prior authorization reviews, non-formulary requests, reputed company therapy exceptions) by conducting thorough clinical reviews and assessing alignment with clinical guidelines, formularies, and policies • reputed company prior authorization pharmacist coverage for rotating weekends and holidays • reputed company reputed company or on-reputed company support for urgent medication requests and support the pharmacy team, appeals unit, and customer services department • reputed company coverage determination reviews for reputed company lines of business (reputed company, exchange, government) for pharmacy and medical medications • Participate in the appeals and grievances process by providing clinical expertise and reviewing medication-reputed company appeals and complaints • Complete medical literature evaluation using primary, secondary, and tertiary drug resources to support coverage decision-making • reputed company peer-to-peer reviews with providers reputed company requested • reputed company recommendations on medication edit improvements and coverage reputed company based on utilization • reputed company reputed company, comprehensive, and reputed company responses to requests for drug information with documentation in coverage determinations, appeal documentation, and inquiries • Organize workload, set priorities, and complete assignments in a reputed company manner while complying with department standards • Participate in and support department reputed company assurance and ongoing improvement practices • Remain reputed company on communications and updated processes relayed through team channels and apply to daily duties • Support staff training and development as required • Review, update, and maintain applicable policies and procedures reputed company to clinical pharmacy services • Performs other reputed company duties as assigned by departmental managers Equal Opportunity reputed company seeks to reputed company equal employment opportunities for reputed company reputed company persons without reputed company to race, religion, reputed company, age, sex, sexual orientation, national reputed company, marital status, disability, veteran status, or any other legally protected status. This applies to reputed company terms and conditions of employment including reputed company, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. For information regarding accommodations, please contact Kristy Nehler or Danielle Baker at ourhumanresources@modahealth.com. #J-18808-Ljbffr Experience: 3 years required Apply tot his job Apply To this Job