Pharmacist I, Clinical Prior Authorization

Navitus Health Solutions

United States

Remote

USD 101,000 - 127,000

Full time

5 days ago

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Benefits offered by this job

Health/Dental/Vision

Paid time off

Parental leave

Paid holidays

401K match

Adoption assistance

FSAs

Educational assistance

Professional membership support

Referral bonus

Job summary

Navitus Health Solutions is hiring a Pharmacist I, Clinical Prior Authorization to perform Prior Authorizations, Drug Utilization Review and related clinical support. You will liaise with physicians, pharmacists and specialty providers to optimize benefits and therapeutic interventions.

The role requires a Doctor of Pharmacy or equivalent with an active license, plus experience in a clinical or managed care setting. This position offers remote work with a comprehensive benefits package.

Qualifications

Bachelor’s degree in Pharmacy or PharmD with active, unrestricted license.
Two years’ clinical or managed care pharmacy experience preferred.
Knowledge of PBM industry, formulary management and care principles.
Strong clinical judgment and ability to translate information for clinical systems.

Responsibilities

Support and input to health management, DUR, formulary and PA programs.
Review requests in Coverage Determination and communicate clearly with stakeholders.
Monitor quality and efficiency of coverage determinations and denial language.
Provide clinical input for new and existing programs and trainings.

Skills

Clinical judgment

PBM knowledge

Pharmacology

Communication skills

Problem solving

MS Office

Team collaboration

Drug literature

Education

Pharmacy degree (B.Pharm or PharmD)

Active pharmacist license

Tools

MS Word

Excel

PowerPoint

Micromedex

Medline

Job description

About Us

Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities. ____________________________________________________We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.

Pay Range

USD $101,335.00 - USD $126,669.19 /Yr.

STAR Bonus % (At Risk Maximum)

10.00 - Pharm, Supvr, AsMgr, SrCSEII, PrgMgr, SrPrgMgr, SrProdMgr

Work Schedule Description (e.g. M-F 8am To 5pm)

M-F 8am-5pm holidays, weekends, on-call

Remote Work Notification

ATTENTION: Navitus is only able to offer remote work to residents of Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Washington DC, Wisconsin.

Overview

Due to growth, we are adding a Pharmacist I, Clinical Prior Authorization to our team!

The Pharmacist I, Clinical Prior Authorization will be responsible for: performing Prior Authorizations; perform duties related to Drug Utilization Review including concurrent, retrospective, and prospective components; and support Customer Care with clinical calls requiring pharmacist intervention. The Pharmacist I, Clinical Prior Authorization is also responsible for interfacing with physicians, pharmacists, and specialty pharmacy providers with respect to beneficiaries’ benefits and therapeutic interventions, and reviewing/evaluating the health surveys and utilization data for program management and development.

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team?

Responsible for support and input to clinical programs such as: Health Management, Drug Utilization Review, Formulary development, and Prior Authorization programs to encourage appropriate, high quality, cost effective drug therapy; and to identify opportunities for improvement in efficiency, accuracy, and appropriateness of the programs in place
Participate in the Coverage Determination (Certification, Prior Authorization, Medical Exception, Exception to Coverage, etc.) process be reviewing all requests which are not clearly approvable based on specified criteria (algorithms), making all coverage denial determinations, and identifying themselves by first name, title, and responsibility at Navitus in relation to drug utilization management program administration
Continually monitor the quality and efficiency of the Coverage Determination process including coverage criteria, denial language, and communication with prescribers
Provide input to clinical content of new programs and for maintenance of existing programs
Complete all annual URAC training requirements
Facilitation of communication and education to clients, members, and internal staff regarding clinical daily issues and objectives
Provide support to operational departments on the implementation of various PBM programs and daily functioning in support of member/patient quality of care
Responsible for supporting / providing clinical expertise related to formulary decisions made by the Pharmacy and Therapeutics committee
May review health care survey data for Medicare Part D qualified participants and/or perform phone consultations with Med-D enrollees; aid in documentation of calls; designate enrollees for repeat interaction
Other duties as assigned

Qualifications

What our team expects from you?

A minimum of a bachelor’s degree in Pharmacy or Pharm D. Current, unrestricted licensure as a Registered Pharmacist in the state of residence, or the ability to gain reciprocity within 4 months, may be required based on state of residence laws or client contracts. Other State Pharmacy Licenses may be required as business need dictates. Must continually maintain education credits to maintain active licensure.
Two years’ work experience in a clinical setting, or clinical or managed care pharmacy practice residency preferred
Knowledge of PBM industry, formulary management, pharmacy claims and managed care principles and practices desired
Exceptional clinical skills and ability to apply sound clinical judgment to a variety of situations is necessary
Proficiency in drug literature and clinical trial evaluation, including proficiency with electronic databases (e.g., Micromedex, Medline, Internet) preferred
Ability to reason and translate clinical information into a manner appropriate for clinical systems and clinical/non-clinical audiences
Emphasis on problem-solving skills, including identifying and accepting a challenging situation and creating and implementing a solution
Requires attention to details to assure projects are clinically, editorially, and systems accurate and can be operationalized
Proficiency in MS Word, Excel, Power Point including tables, charts and figures preferred
Participate in, adhere to, and support compliance program objectives
The ability to consistently interact cooperatively and respectfully with other employees