Remote Prior Authorization Pharmacist — Medicare Part D

A-Line Staffing Solutions; Woonsocket (RI); Presencial; USD 62 000 - 83 000; Tempo integral

Resumo da oferta

A-Line Staffing Solutions is seeking a licensed Pharmacist to remotely review and process prior authorization requests, ensuring medical necessity and regulatory compliance. You will evaluate clinical data, apply coverage policies, and determine determinations for diverse cases.

The role supports Medicare Part D processes, communicates outcomes to providers and patients, and handles high-volume workflow while collaborating with physicians and healthcare teams.

Qualificações

• Active Pharmacist license required.
• 2+ years of prior authorization review experience.
• PBM/managed care or health plan experience preferred.
• Remote work experience preferred.

Responsabilidades

• Review prior authorization requests for accuracy, appropriateness, and medical necessity.
• Gather and evaluate clinical information, coverage policies, and authorization criteria.
• Make coverage determinations per regulatory and plan guidelines.
• Process Medicare Part D approvals and denials.
• Communicate approvals, denials, and incomplete requests to providers and patients.

Conhecimentos

Clinical judgment

Communication

Documentation

Formação académica

Active Pharmacist license

Descrição da oferta de emprego

A-Line Staffing Solutions is seeking a licensed Pharmacist to remotely review and process prior authorization requests, ensuring medical necessity and regulatory compliance. You will evaluate clinical data, apply coverage policies, and determine determinations for diverse cases.

The role supports Medicare Part D processes, communicates outcomes to providers and patients, and handles high-volume workflow while collaborating with physicians and healthcare teams.