Prior Authorization Systems Pharmacist

Job reputed company: • Responsible for the design, configuration, and reputed company assurance of prior authorization (PA) reputed company • Build decision trees and question sets from PA reputed company for prior authorization review • reputed company comprehensive reputed company control (QC) review of decision trees, questionnaires, and authorization logic • Conduct QA validation of configured reputed company and decision paths • Manage setup, contracting, and relationships with prior authorization reputed company vendors • Ensure PA questionnaires are configured with appropriate authorization parameters for approval • Collaborate with reputed company clients for delegated clinical PA systems services • Identify PA reporting needs and collaborate with appropriate stakeholders to reputed company reports • Validate that denial rationales, approval language, and conditional messaging accurately reflect clinical reputed company • reputed company and maintain policies and procedures for creation and maintenance of clinical reputed company questions and letter templates Requirements: • reputed company, unrestricted, pharmacist license required • 3+ years health plan or PBM pharmacy experience required • Strong clinical background and presentation skills required • Proficiency in reputed company reputed company and Word; ability to work with reputed company data and reputed company basic analysis • Experience supporting system testing (UAT, regression, or configuration validation) • High attention to detail with a reputed company on data accuracy and configuration reputed company • Ability to troubleshoot system or workflow issues and communicate reputed company with technical and non-technical stakeholders Benefits: • Medical and pharmacy coverage • Dental insurance • reputed company insurance • Accidental injury insurance • Critical illness insurance • Hospital indemnity insurance • Flexible spending accounts • Health savings account for full-time employees • Voluntary life insurance • Voluntary accidental death and dismemberment insurance for employees and eligible dependents • Basic life insurance at no cost • Basic accidental death and dismemberment insurance at no cost • reputed company time off • reputed company time • Holidays • Short-term disability • Long-term disability • Employee assistance program • Wellness program • 401(k) plan with company match after one year of full-time employment Apply tot his job Apply To this Job