Pharmacist (R)

Ohm Systems; Philadelphia (Philadelphia County); On-site; USD 110,000 - 140,000; Full time

Job summary

PerformRx is seeking a licensed Pharmacist (R) to join the Prior Authorization Department in Philadelphia. The role focuses on making determinations on prior authorization requests, including medical necessity and benefit decisions, in accordance with guidelines and regulations.

The position involves independent reviews with supervisory support, and a rotating weekend schedule based on business needs. A pharmacy license in good standing is required, with a preference for PA/Coverage

Qualifications

• Active pharmacist license in good standing in any U.S. state.
• PharmD degree or equivalent; licensure required.
• Experience with Prior Authorization or Coverage Determination is preferred.

Responsibilities

• Make determinations on prior authorization requests for coverage of pharmaceutical products.
• Work independently with support from Pharmacist II and supervisors.
• Rotate weekend schedule if business needs dictate.
• Provide clinical support to the Customer Care Center.
• Engage providers to support determinations.
• Stay updated on industry trends and regulatory changes.

Skills

No experience required

PA/Coverage review

Windows PC skills

Education

Bachelor's Degree

PharmD preferred

Current Pharmacist license

Job description

Shift

• The position is scheduled for Monday through Friday, 10:00 AM to 6:00 PM, with a potential Saturday rotation based on business needs. Please note that the shift schedule may also be adjusted in the future to meet operational demands.

Note

• Candidates must hold an active pharmacist license in good standing in any of the 50 U.S. states.

Duties

• As a licensed healthcare professional employed in the Prior Authorization Department the primary responsibility of Pharmacist (R) 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.
• Prior Authorization Pharmacist (R) works independently with respect to reviews and decision making, with the support of Pharmacist II (R)s and supervisors. Pharmacist (R) 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 PerformRx 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