Pharmacist - Prior Authorizations

Managed Staffing, Inc.; United States; Remote; USD 95,000 - 125,000; Full time

Job summary

A healthcare staffing firm is seeking a Remote Clinical Pharmacist with prior authorization experience to join their team. The role involves evaluating and reviewing prior authorization requests, consulting with healthcare providers, and ensuring timely communication of decisions. Candidates must be licensed pharmacists in North Carolina but can reside in any state. This position is crucial for maintaining compliance with clinical criteria and managing approval processes effectively.

Responsibilities

• Evaluate and review prior authorization requests.
• Consult with healthcare providers and physicians.
• Ensure timely delivery of coverage decisions.

Skills

Remote Prior Authorization Experience

Clinical Knowledge

Effective Communication

Education

Licensed Pharmacist in North Carolina

Job description

Looking for Pharmacist who have Remote Prior Authorization Experience & Must be licensed in the state of North Carolina. (Can reside in any state.)

This position is for a Clinical Pharmacist working in the Prior Authorization team.

This Pharmacist will:

• Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design. Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians, and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols. One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed‑upon approval & denial management processes.