Job Description
Compensation
Pay Rate: $53.00 per hour
Full-time employees are eligible for benefits after 90 days of employment.
A 401(k) plan with a company match is available for full-time employees after one year of service.
Position Highlights
This role is a contract assignment with the potential for permanent hire based on attendance, performance, and business needs.
Required availability is either Sunday-Thursday or Tuesday-Saturday, with shifts from:
10:30 AM - 7:00 PM
11:00 AM - 7:30 PM
11:30 AM - 8:00 PM
Key Responsibilities
Evaluate and review all prior authorization requests to render coverage determinations based on clinical criteria and plan design. This includes verifying insurance coverage, interpreting clinical guidelines, consulting with physicians and other healthcare providers, and utilizing clinical knowledge while adhering to departmental protocols.
Communicate decisions regarding cases promptly and efficiently to healthcare providers, health plans, employers, patients, and other healthcare professionals, following established approval and denial management processes.
Collaborate with technicians and team members to process referrals, address clinical questions, and gather the necessary clinical and medical data for assessments as per health plan criteria within designated service level agreements.
Handle inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and patients to facilitate prior authorization requests, answer inquiries, and resolve escalations.
Maintain up-to-date professional and technical knowledge of drug and disease states for both Specialty and Non-Specialty Pharmacy programs within the Commercial Prior Authorization and Case Review Unit.
Perform other related projects and duties as assigned, including attending training sessions and development meetings, and providing on-call and after-hours pharmacist availability as needed.
Requirements
High School Diploma.
Attendance is mandatory for the first 90 days.
Must be a Licensed Registered Pharmacist.
1-3 years of experience in prior authorization.
Willingness to work mandatory overtime or extended work weeks as needed.
Compliance with departmental, state, and federal regulations when processing information to ensure accuracy for internal and external customers.
Preferred Qualifications
3-5 years of experience in prior authorization.
If you believe the Remote Prior Authorization Pharmacist position is a great fit for you, we encourage you to call, email, or apply to this posting!
Employment Type: Full-Time
Salary: $ 53.00 Per Hour
Job Tags
Hourly pay, Permanent employment, Full time, Contract work, Shift work, Sunday, Saturday,