Pharmacist - RPh Operations Advisor - Specialty Medical Prior Authorization Aetna

US Tech Solutions; United States; Remote; USD 80,000 - 120,000; Full time

Job summary

A leading company in healthcare staffing is seeking a clinical pharmacist to conduct medical data reviews for specialty medications and handle prior authorizations. The successful candidate will have a Pharm D. and experience in managed care, as well as a strong understanding of Medicare/Medicaid. Responsibilities include coordinating with healthcare professionals to handle authorization requests and ensure seamless communication. Join our team to make a meaningful impact in patient care and manage critical pharmacy services.

Qualifications

• Minimum of 2-5 years of clinical experience with specialty medications or clinical review of prior authorization requests.
• Active pharmacy license in the state of residence in good standing.

Responsibilities

• Conducts clinical reviews of medical data for prior authorizations.
• Handles inbound calls regarding prior authorization.
• Collaborates with healthcare staff to process authorization requests.

Skills

Managed care experience

Medicare/Medicaid knowledge

Prior Authorization experience

Pharmacy Benefit Management (PBM) experience

Education

Pharm D.

Tools

MS Office

Job description

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.

Questionnaire:

• How many years of prior-authorization experience do you have?
• Haw many Prior Auth cases have you handled in your last role?
• Do you have experience in handling calls regarding prior authorization and appeals?

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, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.