Pharmacist

Apex Systems; Pittsburgh (Allegheny County); On-site; USD 70,000 - 90,000; Full time

Job summary

An IT staffing and services firm is seeking a Pharmacist to review clinical coverage determinations and appeals. The ideal candidate should be self-motivated with keen attention to detail and strong organizational skills. Responsibilities include conducting data analysis, managing medication exception requests, and ensuring compliance with quality standards. Candidates should have 2-5 years of experience and excellent verbal and written communication skills. Flexibility in scheduling for night, weekend, and holiday coverage is required.

Qualifications

• 2-5 years of experience in a relevant role.
• Ability to maintain patient confidentiality.
• Demonstrated resourcefulness in problem-solving.

Responsibilities

• Review clinical coverage determinations and appeals.
• Assist in meeting clients’ expectations for efficiency and quality.
• Complete data entry and analyze various clinical projects.

Skills

Self-motivated with strong attention to detail

Excellent verbal and written communication skills

Proficient computer skills in a Windows environment

Ability to work in a high-pressure environment

Strong organizational skills

Job description

Apex Systems LLC, a division of On Assignment, is an IT staffing and services firm specializing in providing IT professionals for contract, contract-to-hire, and direct placements. Apex also offers recruitment solutions for other select professional skills and workforce needs

Job Description

Position Summary: Responsible for reviewing clinical coverage determination and appeals using Medicare and client specific requirements. Knowledgeable in all aspects of coverage determination and appeals process and assist in meeting clients expectations regarding efficiency, services levels, privacy maintenance and quality decision making. Work as part of the team to meet business unit objectives. The Pharmacist will be responsible for reviewing medication exception request, as well as completing data analysis and various clinical projects. Escalate issues to Coverage Determinations and Appeals management team as needed. Position will require schedule flexibility including rotations through nights, weekend and holiday coverage. All other duties are required to meet business needs.

Duties: Responsibilities :

• 1. Review the information provided upon request by utilizing the designated tools (web based) for further research. High proficiency in computer skills is necessary including but not limited to Microsoft Word, Microsoft Excel, and web based programs. 60%
• 2. Outreach for additional information. May include Pharmacy, Prescribers, Members, etc. as appropriate 25%
• 3. Data Entry (Electronic Database) recording decision making, inputting clinical notation, request for additional information, faxes, summary, etc. 10%
• 4. Training – attending meetings, online job aides, process changes, new initiatives, communication, etc. both formal and informal training 5%

Qualifications

Experience: REQUIRED SKILLS:

• 1. Self-motivated with a strong attention to detail
• 2. Excellent verbal and written communication and interpersonal skills w/ ability to maintain patient confidentiality
• 4. Customer Service internally and externally
• 5. Proficient computer skills and the ability to navigate in a Windows based environment
• 6. Ability to follow directions, and adapt in dynamic work environment; ability to adapt to change and remain flexible
• 7. Adaption to Change Management
• 8. Ability to work in a high pressure, time sensitive environment
• 9. Project a professional business image, through phone interaction as well as internal communications
• 10. Demonstrates resourcefulness in problem-solving
• 11. Demonstrates a sense of urgency with assignments
• 12. Strong organizational skills
• 13. Able to prioritize and manage multiple tasks
• 14. Ability to read, analyze and interpret general business correspondence, technical procedures and governmental regulations.
• 15. Ability to identify and solve practical problems and deal with a variety of concrete variables in standardized situations. Ability to perform basic mathematic calculations maybe required
• 16. Ability to interpret a variety of work instructions provided through a variety of mediums
• 17. Ability to consistently meet quality and production standards
• 18. Displays confidence in the ability to learn complex material
• 19. Demonstrates intellectual curiosity through inquiries to ensure deep understanding of the business and deliver accurate results 2 years experience required, 2-5 years experience preferred.