IL
Pharmacist - Prior Authorizations
ICONMA, LLC
🇺🇸 United States
Remote
5 months ago
$50 – $55 / hour
- prior authorization
- PharmD
5 months ago
Not enough detail in this posting to match
Responsibilities:
- Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design.
- Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols.
- One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval & denial management processes.
- Collaborate with the technicians and prior authorization team members to process referrals, including answering clinical questions and collecting appropriate clinical/medical data needed to perform clinical assessments and reviews as per the health plan/employer- agreed criteria within the designated service level agreements.
- Performs and handles in bound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations.
- Maintain professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered within the Commercial Prior Authorization and Case Review Unit (CRU) line of business.
- Perform other related projects and duties as assigned, including attending training sessions and development meetings, and providing on-call and after-hours pharmacist avail ability as needed.
- Demonstrated experience using clinical resources, e g., Micromedex, Lexicomp, Clinical Pharmacology
- Ability to prioritize, quickly assess, manage multiple tasks and adapt to constantly changing situations.
Requirements:
- Excellent organizational skills. Strong detail orientation.
- Strong Microsoft Office skills.
- Ability to receive phone calls from prior authorization pharmacy technicians and/or providers for clinical information.
- Minimum 2 years’ recent experience reviewing and processing prior authorizations against health plan criteria for a determination in a specialty/skilled clinical setting i.e., specialty medical office or Pharmacy Benefits Manager (PBM)
- Bachelor’s degree in pharmacy or PharmD
Why Should You Apply?
- Health Benefits
- Referral Program
- Excellent growth and advancement opportunities
ICONMA is an Equal Opportunity Employer. All qualified applicants will receive considerationfor employment without regard to any status protected by applicable law.
Pharmacist - Prior Authorizations · ICONMA, LLC