Pharmacist - RPh Operations Advisor

US Tech Solutions; United States; On-site; USD 80,000 - 100,000; Full time

Job summary

US Tech Solutions is looking for a clinical pharmacist to perform clinical reviews and manage prior authorizations for specialty medications. This operation-based role requires an active Pharm D and experience in managed care. The position supports healthcare decisions through comprehensive authorization processes.

Qualifications

• Minimum 2-5 years of clinical experience with specialty medications preferred.
• Active pharmacist license required.
• Experience in a managed care environment is crucial.

Responsibilities

• Conduct clinical reviews for prior authorizations of specialty medications.
• Collaborate with healthcare professionals to process authorization requests.
• Handle inbound calls regarding prior authorizations.

Skills

Managed Care Experience

Medicare/Medicaid Knowledge

Prior Authorization Experience

Pharmacy Benefit Management (PBM) Experience

Education

Pharm D

Tools

MS Office

Job description

This range is provided by US Tech Solutions. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$53.00/hr - $55.00/hr

Duration: 6+ months contract

Job Description:

• The clinical pharmacist is an operation based role that conducts clinical reviews of medical data collected to perform prior authorization for specialty medications.
• The clinical pharmacist will apply clinical knowledge to plan approved criteria for prospective and concurrent reviews of cases.
• This role will work from Pharmacy SSsupported systems and take inbound calls from physician or members regarding their pending, approved, or denied prior authorizations.

Responsibilities:

• Collaborates with the Technicians and Nurses to process authorization requests, including answering clinical questions, collecting appropriate clinical/ medical data needed to perform clinical assessments, and reviews as per the health plan/employer agreed criteria within the designated service level agreements. (20%)
• Coordinates timely communication of case decision to physician, health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes. (15%)
• Handles inbound phone calls and escalations from physicians or patients regarding Prior Authorization (50%)
• Establishes and maintains communication among CVS Caremark, health plan and employer group staff. (5%)
• Maintain professional and technical knowledge of drug and disease-states for the Specialty Medical programs administered within the Novologix. (5%)
• Performs other related projects and duties as assigned including on call and after hours pharmacist availability could be required. (5%)

Experience:

• Minimum of 2-5 years of clinical experience with specialty medications or clinical review of prior authorization requests is preferred.
• Experience using MS Office and other Windows based computer applications, strong organizational skills, interpersonal skills, and detail orientation are important for this position.

Skills:

• MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge.
• MUST HAVE 6 months of experienced with Prior Authorization(required).
• MUST HAVE experience with Medicare Part D
• Must Have Pharmacy Benefit Management (PBM) experience.

Education:

• Pharm D. required with at least two years experience as a pharmacist in Managed care environment.
• Must have an active license in the state of residence in good standing.

About US Tech Solutions:

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com.

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Recruiter Details:

Email: [e-mail]

Job ID: 25-40715

Seniority level

• Seniority level

  Associate

Employment type

• Employment type

  Contract

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

Referrals increase your chances of interviewing at US Tech Solutions by 2x

Get notified about new Pharmacist jobs in United States.

Remote Clinical Pharmacist (Start of Care)

Pharmacy Care Coordinator - National Remote

Portland, OR $101,855.89-$129,864.20 1 week ago

United States $98,384.00-$122,980.00 2 weeks ago

United States $115,000.00-$118,000.00 2 weeks ago

Florida, United States $182,100.00-$345,600.00 1 day ago

Remote Certified Pharmacy Technician (Start of Care)

Remote Certified Pharmacy Technician (Start of Care)

Missouri, United States $182,100.00-$345,600.00 1 day ago

United States $180,300.00-$234,600.00 57 minutes ago

Florida, United States $53.87-$59.86 1 week ago

United States $126,422.00-$189,634.00 2 days ago

Lees Summit, MO $240,438.00-$360,657.00 4 days ago

Texas, United States $182,100.00-$345,600.00 1 day ago

Texas, United States $18.18-$25.80 6 days ago

North Carolina, United States $182,100.00-$345,600.00 1 day ago

California, United States $182,100.00-$345,600.00 1 day ago

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.