Clinical Pharmacist: Prior Authorization & Coverage Reviews

ASK Consulting; New Shoreham (RI); Sur place; USD 110 000 - 140 000; Plein temps

Résumé du poste

ASK Consulting seeks a Clinical Pharmacist to resolve coverage determinations and redeterminations timely. You will interact with health care professionals by phone or fax to coordinate patient care and support providers.

The role requires a Pharm D. with an active state license and at least 1 year of clinical pharmacy experience, preferably with managed care (Medicaid/Medicare). Strong communication and Excel/SharePoint skills are important.

Qualifications

• Pharm D. required with active license in good standing.
• Active license must be in the state of residence with no restrictions.
• Experience with prior authorization is preferred.
• Knowledge of managed care (Medicaid/Medicare) preferred.
• Strong communication and documentation skills.

Responsabilités

• Complete clinical reviews for Medicare-Medicaid Coverage Determination/Redetermination and other determinations by reviewing requests per criteria.
• Monitor Prior Authorization process quality and communication with prescribers and members; provide recommendations to physicians.
• Complete annual NCQA, Aetna required training requirements.
• Assist Member Services and internal customers with pharmacy-related inquiries.
• Maintain open lines of communication with other departments.
• Stay current with clinical literature and relay findings to program development teams.

Connaissances

Clinical pharmacy experience

Active state license

Prior authorization experience

MS Office

SharePoint

Strong communication

Managed care experience

Board certification

Residency preferred

Formation

Pharm D. degree

Description du poste

ASK Consulting seeks a Clinical Pharmacist to resolve coverage determinations and redeterminations timely. You will interact with health care professionals by phone or fax to coordinate patient care and support providers.

The role requires a Pharm D. with an active state license and at least 1 year of clinical pharmacy experience, preferably with managed care (Medicaid/Medicare). Strong communication and Excel/SharePoint skills are important.