Clinical Pharmacist - Prior Authorization & Compliance

Blue Cross and Blue Shield of North Carolina; United States; In loco; USD 119.000 - 190.000; Tempo pieno

Vantaggi offerti da questo lavoro

Annual Incentive Bonus

401(k) with employer match

Paid Time Off (PTO)

Health benefits and wellness programs

Descrizione del lavoro

Blue Cross NC is seeking a pharmacist to provide timely drug therapy for health plan members by reviewing and processing prior authorization requests using clinical judgment and medical policy.

You will review prior authorization requests, report utilization statistics, support Pharmacy and Therapeutics activities, and guide pharmacy technicians while ensuring compliance with coding and adjudication standards.

Competenze

• Bachelor's degree or advanced degree required.
• 3+ years of related field experience.
• Current state pharmacy license required.

Mansioni

• Review prior authorization requests and make determinations for drug products according to member benefits and coverage criteria
• Report utilization review statistics to corporate compliance committees
• Review data and summarize daily utilization review numbers
• Responsible for tracking compliance of review cases
• Provide clinical guidance and support to the assigned pharmacy technicians
• Knowledge of drug coding (NDC, GCN, GPI and USC) and NCPDP claims adjudication systems
• Review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design.
• Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practices
• Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews

Conoscenze

Clinical Compliance

Drug Coding

Drug Information

Medical Knowledge

Medical Policy

Medical Prescriptions

Medicare

Medication Adherence

Medication Management

Medication Reconciliation

Medication Safety

Medication Therapy Management

Pharmacy

Pharmacy Operations

Pharmacy Regulation

Formazione

Bachelor's degree or advanced degree

Descrizione del lavoro

Blue Cross NC is seeking a pharmacist to provide timely drug therapy for health plan members by reviewing and processing prior authorization requests using clinical judgment and medical policy.

You will review prior authorization requests, report utilization statistics, support Pharmacy and Therapeutics activities, and guide pharmacy technicians while ensuring compliance with coding and adjudication standards.