Pharmacist I, Clinical Prior Authorization

Navitus Health Solutions, LLC; United States; Remote; USD 101.000 - 127.000; Vollzeit

Benefits dieser Stelle

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

9 holidays

401K company match

Adoption assistance

Flexible Spending Account

Educational assistance

Professional membership assistance

Referral bonus program

Zusammenfassung

Navitus is seeking a Pharmacist I, Clinical Prior Authorization to join our team in the United States. You will perform Prior Authorizations and Drug Utilization Reviews, interfacing with physicians, pharmacists and providers to support beneficiary benefits and clinical interventions.

You will contribute to program management, health outcomes, and the education of clients and staff while adhering to URAC training and quality standards. This role offers remote work within eligible states.

Qualifikationen

• A bachelor's degree in Pharmacy or Pharm D with active pharmacist licensure in the state of residence.
• Two years’ clinical or managed care pharmacy experience preferred.
• Knowledge of PBM industry, formulary management and pharmacy claims desirable.
• Strong clinical judgment and ability to translate clinical information for diverse audiences.
• Proficiency in drug literature and clinical trial evaluation; familiarity with Micromedex/Medline is preferred.

Aufgaben

• Support clinical programs such as Health Management, Drug Utilization Review, Formulary development, and Prior Authorization programs.
• Review coverage determinations and communicate decisions to relevant stakeholders.
• Monitor quality and efficiency of the Coverage Determination process.
• Provide input to clinical content of new programs and maintenance of existing ones.
• Complete URAC training requirements annually and support client communication.
• Assist operational departments with PBM program implementation and daily functions.
• Review Medicare Part D data and perform pharmacy consultations when needed.
• Collaborate with physicians, pharmacists and providers on beneficiary care.

Kenntnisse

Clinical knowledge

Pharmacist licensure

PBM industry knowledge

Problem-solving

Ausbildung

Pharmacy degree (B.Pharm or PharmD)

Tools

MS Word

Excel

PowerPoint

Jobbeschreibung

Company

Navitus

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

What can you expect from Navitus?

• Top of the industry benefits for Health, Dental, and Vision insurance


• 20 days paid time off


• 4 weeks paid parental leave


• 9 paid holidays


• 401K company match of up to 5% - No vesting requirement


• Adoption Assistance Program


• Flexible Spending Account


• Educational Assistance Plan and Professional Membership assistance


• Referral Bonus Program – up to $750!

Location : Address

Remote

Location : Country

US