Clinical Appeals Pharmacist

HireTalent - Staffing & Recruiting Firm; United States; On-site; USD 110,000 - 140,000; Full time

Job summary

HireTalent - Staffing & Recruiting Firm seeks a licensed pharmacist to review and render decisions on authorizations and appeals for specialty and non-specialty drugs, including physician-administered therapies.

Responsibilities include peer-to-peer calls with prescribers to discuss rationale of determinations, participation in clinical audits, and providing internal support for escalations while ensuring compliant and safe use of pharmaceuticals for members and providers.

Qualifications

• Licensed Pharmacist with clinical review experience or willingness to obtain licensure.
• Experience interpreting clinical criteria and applying guidelines in managed care.
• Strong understanding of pharmaceutical use and safety in member care.

Responsibilities

• Review and render decisions on authorizations and appeals for specialty, non-specialty, and physician administered drugs.
• Conduct peer-to-peer calls with prescribers to discuss clinical rationale of adverse determinations.
• Participate in clinical quality audits and inter-rater reliability testing.
• Provide internal team support for escalations and questions.
• Apply clinical expertise to ensure appropriate and safe use of pharmaceuticals by members and providers.
• Compliance with all applicable laws and regulations.
• Other duties as assigned

Skills

Licensed Pharmacist

Clinical Review

Education

Doctor of Pharmacy Degree

Job description

HireTalent - Staffing & Recruiting Firm seeks a licensed pharmacist to review and render decisions on authorizations and appeals for specialty and non-specialty drugs, including physician-administered therapies.

Responsibilities include peer-to-peer calls with prescribers to discuss rationale of determinations, participation in clinical audits, and providing internal support for escalations while ensuring compliant and safe use of pharmaceuticals for members and providers.