Registered Nurse - IL only

Apidel.be; Illinois; On-site; USD 110,000 - 140,000; Full time

Job summary

Apidel.be is seeking a Clinical Pharmacist to perform prospective and concurrent reviews for prior authorizations on specialty medications. The role involves coordinating data collection, responding to physicians and patients, and ensuring adherence to health plan criteria within service level agreements.

Requirements include an active pharmacist license, a PharmD or Bachelor’s in Pharmacy with two years of pharmacy experience, and expertise with specialty medications.

Qualifications

• Active pharmacist license in state of residence in good standing.
• Bachelor's degree in pharmacy or PharmD with at least two years’ experience as a pharmacist.
• Experience with specialty medications or clinical review of prior authorization requests.

Responsibilities

• Collaborates with technicians and nurses to process authorization requests, including answering clinical questions and collecting data for clinical assessments.
• Coordinates timely communication of case decisions to physician, health-plan/employer, patient and other healthcare professionals.
• Handles inbound calls and escalations from physicians or patients regarding Prior Authorization.
• Establishes and maintains communication with health plan and employer staff.
• Maintains knowledge of drug and disease states for Specialty Medical programs.
• Performs other related projects and duties as assigned including on call and after-hours availability.

Skills

Interpersonal skills

Organizational skills

Attention to detail

Education

PharmD

Bachelor's in Pharmacy

Active pharmacist license

Tools

MS Office

Job description

Duration: 12+ Months (with possibilities of extension)

Shift: 7am to 10pm CST - 8 hours/day Training: M-F 8-4:30PM CST for 6 weeks *Possible weekend shifts*

Position Summary

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 supported systems and take inbound calls from physician or members regarding their pending, approved, or denied prior authorizations.

This individual must have excellent interpersonal skills. Will be responsible for:

• 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, 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

2+ years of clinical experience with *specialty medications* or *clinical review of prior authorization requests*.

Experience using MS Office and other Windows based computer applications, strong organizational skills, interpersonal skills, and detail orientation are important for this position.

Required certification

Active pharmacist license in state of residence in good standing

Education

Bachelor's degree in pharmacy or Pharm D. required with at least two years’ experience as a pharmacist. Must have an active license in good standing.