Pharmacist (R)

TALENT Software Services; Philadelphia (Philadelphia County); On-site; USD 90,000 - 120,000; Full time

Job summary

The Prior Authorization Department at TALENT Software Services seeks a licensed pharmacist to determine prior authorization requests for coverage of pharmaceutical products. You will apply medical necessity and benefit criteria, following established guidelines and regulations.

In this role you will work independently with support from Pharmacist II (R)s and supervisors, contributing to a team that strives to meet quality standards and customer guarantees.

Qualifications

• Bachelor's Degree required; PharmD preferred.
• Current Pharmacist license required.
• Prior Authorization or coverage determination experience preferred.

Responsibilities

• Make determinations on prior authorization requests for pharmaceutical product coverage.
• Determinations include medical necessity and benefit decisions.
• Follow established pharmacy guidelines, prior authorization criteria, industry regulations, and sound clinical judgment.
• Work independently with support of Pharmacist II (R)s and supervisors.
• Collaborate with peers to meet quality standards and customer performance guarantees.
• Rotating weekend schedule may apply.

Skills

Prior Authorization experience

Windows PC skills

Education

PharmD preferred

Current Pharmacist license

Job description

Primary Responsibilities

• As a licensed healthcare professional employed in the Prior Authorization Department, the primary responsibility is to make determinations on prior authorization requests for coverage of pharmaceutical products.
• Determinations include medical necessity and benefit decisions.
• Decisions are made in accordance with established pharmacy guidelines, prior authorization criteria, industry regulations, and sound clinical judgment.
• Works independently with respect to reviews and decision-making, with the support of Pharmacist II (R)s and supervisors.
• Works as a member of a team of peers committed to meeting or exceeding quality standards and customer performance guarantees.
• This position includes a rotating weekend schedule if business needs dictate.

Duties

• As a licensed healthcare professional employed in the Prior Authorization Department, the primary responsibility is to make determinations on prior authorization requests for coverage of pharmaceutical products.
• Determinations include medical necessity and benefit decisions.
• Decisions are made in accordance with established pharmacy guidelines, prior authorization criteria, industry regulations, and sound clinical judgment.
• Works independently with respect to reviews and decision-making, with the support of Pharmacist II (R)s and supervisors.
• Works as a member of a team of peers committed to meeting or exceeding quality standards and customer performance guarantees.
• This position includes a rotating weekend schedule if business needs dictate.

Additional responsibilities include

• Provide clinical support to the Customer Care Center
• Engage providers in discussions to support determinations
• Support Fraud and Abuse program oversight
• Keep abreast of industry trends and regulatory changes
• Keep abreast of operational directives and customer reference materials

Skills

• No experience required, Prior Authorization or Coverage Determination experience preferred
• Proficient PC skills in a Windows-based environment

Education

• Bachelor's Degree, PharmD preferred
• Current Pharmacist license