Pharmacist (R)

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

Job summary

TALENT Software Services seeks a licensed healthcare professional to join the Prior Authorization Department in the Philadelphia area. The role centers on determining coverage for pharmaceutical products, including medical necessity and benefit decisions, with oversight from Pharmacist II (R)s and supervisors.

You will work as part of a team dedicated to quality standards and customer performance, with a rotating weekend schedule as needed to meet business demands.

Qualifications

• Licensed healthcare professional acting in Prior Authorization decisions.
• Must be able to evaluate medical necessity and benefit coverage.

Responsibilities

• Make determinations on prior authorization requests for coverage of pharmaceutical products.
• Determine medical necessity and benefit decisions.
• Follow pharmacy guidelines, POA criteria, regulations, and clinical judgment.

Skills

Prior Authorization

Windows Proficiency

Job description

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

• 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.