Prior Authorization Pharmacist -PBM settings/Medicare part D

LanceSoft Inc.,; United States; Remote; Full time

Job summary

An established industry player is seeking a Clinical Pharmacist to join their team in a fully remote capacity. This role involves supporting Medicare Part D members and providers, ensuring accurate case setups, and reviewing clinical information for decision-making. The ideal candidate will have a strong background in pharmacy and excellent interpersonal skills to provide top-notch service. You'll be part of a dynamic team dedicated to enhancing healthcare experiences while working from the comfort of your home. If you're passionate about making a difference in healthcare, this opportunity is perfect for you!

Qualifications

• Active pharmacist license required in the state of residence.
• Must provide high-speed internet with specified minimum speeds.

Responsibilities

• Support Medicare Part D members with pharmacy benefit requests.
• Review clinical information and ensure accurate decisions.

Skills

Interpersonal Skills

Organizational Skills

Detail Orientation

Basic Computer Skills

Education

High School Diploma or GED

Bachelor's Degree in Pharmacy or Pharm D.

Tools

VPN Token

Smartphone

Job description

Direct message the job poster from LanceSoft Inc.,

*Clinical Pharmacist - PBM settings/Prior Authorization

Position type: Full time

Location: Fully remote

Onsite Flexibility: All Remote

Pay range: ($51.00 - $58.00)

Schedule: Training hours M-F 9a-5:30p EST. After training 8hr Shift M-F with a weekend schedule.

Description:

As an RPh Advisor, you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. You will be responsible for ensuring cases are accurately set up for our members, reviewing clinical information for decisioning the request, performing outreach to providers for more information when needed, and ensuring accurate decisions that comply with compendia and Medicare guidance and timelines. This is a great opportunity to initiate a career with a leading healthcare company by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience.

Call Center: They need a pharmacist license in their state of residence.

Requirements:

• Must list internet speed test on the resume - www.speedtest.net
• Must have active license listed on the Resume as well
• Must provide their own high-speed internet with a minimal home broadband connectivity speed of 25 Mb download and 5 MB upload speed.
• Smartphones are required. The VPN token will need to be downloaded to the user’s smartphone.
• Must have a sufficient/private work area that is used for business during their work hours.
• Current living accommodations must be in a stable situation.
• The assignment could be changed to an in-office assignment.
• Ensure awareness of the Teleworker Privacy Practices.
• Take steps to ensure that the work area is secure and protects property and confidential information.
• Workspace must be dedicated to business during working hours and not accessible by others.
• When not working, the computer must be shut off. For short departures, the workstation must be locked or the computer shut down.

Duties:

This individual must have excellent interpersonal skills. Will be responsible for reviewing and completing criteria based on prior authorization as per policy and procedure.

Experience:

• Previous pharmacy experience in PBM (Pharmacy Benefits Management) required.
• Appropriate state license required in the state of residence.
• Basic computer skills required. Strong organizational skills, interpersonal skills, and detail orientation important for this position.
• PBM Prior Authorization review experience preferred.

Position Summary:

This position is responsible for reviewing and completing criteria based on prior authorization as per policy and procedures.

Education:

High School Diploma or GED required. Bachelor's degree in pharmacy or Pharm D. also required with at least two years’ experience as a pharmacist. Must have an active license in the state of residence in good standing.

About LanceSoft:

LanceSoft is a certified Minority Business Enterprise (MBE) and an equal opportunity employer. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.

This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. LanceSoft makes hiring decisions based solely on qualifications, merit, and business needs at the time.

LanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients.

EEO Employer

Seniority level

• Entry level

Employment type

• Full-time

Job function

• Health Care Provider
• Industries: IT Services and IT Consulting