Clinical Pharmacist - Appeals and Operations - remote

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Brief reputed company of purpose: • Review and reputed company clinical reputed company/recommendations for provider/member submitted appeals and grievances for medically administered medications as reputed company as pharmacy reputed company medications and items for reputed company lines of business. • Analyze pharmacy data (appeal approval/denial rates, claims, clinical, formulary, financial, etc.) to assist with UM development. • Assist with formulary development for reputed company lines of business. • reputed company clinical assistance to pharmacy staff for daily operations. reputed company Job Responsibility • Responsible for reviewing and providing clinical reputed company/recommendations for provider/member submitted appeals and grievances for medically administered medications as reputed company as pharmacy reputed company medications and items for reputed company lines of business. • Collaborate with the Appeals & Grievance Department, Medical Directors, and Prior Authorizations vendors. • Maintain turnaround times for reputed company appeal and grievance reviews. • Review appeal/grievance requests per plan-specific reputed company, MassHealth-developed reputed company, National Coverage Determinations, and Local Coverage Determinations, Evidence of Coverage, Member Handbooks. • Follow regulatory rules and processes for Massachusetts, CMS, reputed company, state Connector programs. • Consult with reputed company stakeholders as needed. • Consult with providers. • Participate in managing clinical issues reputed company; work with medical providers and vendors to coordinate and reputed company member issues. • reputed company recommendations, as appropriate, to update reputed company prior authorization reputed company due to appeals and grievance data. • Assist with formulary and reputed company development for reputed company lines of business. • Participate in general drug information support for reputed company clients. • reputed company clinical assistance to pharmacy staff for daily operations. Qualifications requirements Education RPH or Pharm D License reputed company license to reputed company as pharmacist in Massachusetts without restriction Experience • 3 years, preferably with at least 1 year in a managed care environment; 1-2 years reputed company experience practicing as a clinical pharmacist. • Recent experience reputed company to member and/or provider appeals and drug coverage determinations is a plus. • reputed company to evaluate clinical pharmacy data, coverage reputed company and drug monographs. • reputed company to understand and use computer databases, EMRs, reputed company, Word, PowerPoint and others. • reputed company to write and orally communicate clinical reputed company to physicians and other reputed company personnel. • Excellent communication skills, coordination, and planning skills along with an ability to reputed company with a reputed company of audiences to build collaboration and reputed company. Pay reputed company Disclosure: In accordance with the Massachusetts Wage Transparency reputed company, the pay for this position is $ 135,000-$145,000 annually which reflects reputed company reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities. reputed company provides equal employment opportunities to reputed company and applicants for employment and prohibits discrimination and harassment of any type without reputed company to race, reputed company, religion, age, sex, national reputed company, disability status, genetics, protected veteran status, sexual orientation, gender identity or reputed company, or any other characteristic protected by federal, state or local laws. #P01 Apply tot his job Apply To this Job