Retail Pharmacist - Prior Authorizations

ProMedica; United States; Remote; USD 65,000 - 95,000; Full time

Benefits offered by this job

Flexible benefits

Job summary

ProMedica is seeking a pharmacy professional to work remotely, supporting clinic and hospital pharmacy locations. The role reviews prior authorizations, formulary exceptions, payer denials and appeals to facilitate timely access to prescribed therapies.

It also performs clinical reviews of refill authorizations and medication histories, ensuring accuracy and adherence to guidelines. You will provide transitions of care through medication reconciliation, discharge reviews, patient education, and

Responsibilities

• Review and support prior authorizations, formulary exception requests, payer denials and appeals to facilitate timely patient access to prescribed therapies.
• Perform clinical review of medication refill authorization requests and medication histories, ensuring accuracy, appropriateness, adherence to clinical guidelines, and effective communication with patients and providers.
• Support transitions of care through medication reconciliation, discharge medication review, and collaboration with providers to promote safe transitions across care settings.
• Educate patients and coordinate with providers to promote safe and effective medication therapy.

Job description

Location:

Toledo HospitalDepartment:

PharmacyWeekly Hours:

40Status:

Full timeShift:

Days (United States of America)

Job Summary:

This position will work remotely to support clinic and pharmacy locations, alongside Prior Authorization Billing Specialists.Reviews and supports prior authorizations, formulary exception requests, payer denials and appeals, and other medication access activities to facilitate timely and appropriate patient access to prescribed therapies. Performs clinical review of medication refill authorization requests and medication histories, ensuring accuracy, appropriateness, adherence to clinical guidelines, and effective communication with patients and providers regarding medication therapy. Provides transitions of care services through medication reconciliation, discharge medication review, identification and resolution of medication-related problems, patient education, and collaboration with providers to promote safe and effective transitions across care settings.ProMedica is a mission-driven, not-for-profit health care organization headquartered in Toledo, Ohio. It serves communities across nine states and provides a range of services, including acute and ambulatory care, a dental plan, and academic business lines. ProMedica owns and operates 10 hospitals and has an affiliated interest in one additional hospital. The organization employs over 1,300 health care providers through ProMedica Physicians and has more than 2,300 physicians and advanced practice providers with privileges. Committed to its mission of improving health and well-being, ProMedica has received national recognition for its clinical excellence and its initiatives to address social determinants of health.For more information about ProMedica, please visitpromedica.org/aboutus.

Benefits:

We provide flexible benefits that include compensation and programs to help you take care of your family, your finances and your personal well-being. It’s what makes us one of the best places to work, and helps our employees live and work to their fullest potential.

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact [e-mail]

Equal Opportunity Employer/Drug-Free Workplace