An award-winning, certified woman-owned business headquartered in Troy, Michigan, ICONMA is a global information consulting management firm that specializes in project-based and pr
Pharmacist - Prior Authorizations
Location
California
Posted
37 days ago
Salary
$50 - $55 / hour
Seniority
Senior
Job Description
Pharmacist - Prior Authorizations
ICONMA
Title: Pharmacist - Prior Authorizations Location: Remote, CA $50-$55 per hour Fully Remote Our Client, a Retail Pharmacy company, is looking multiple Pharmacists with prior authorization experience to work remotely. 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 consideration for employment without regard to any status protected by applicable law. #alljobs
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