[Hiring] Pharmacist @US Tech Solutions

Role Description

The Pharmacist – Prior Authorization Advisor is an operation-based role that conducts criteria based & clinical review of medical data collected to perform prior authorization as per policy and procedure.

The Pharmacist/Clinician will apply clinical knowledge to plan approved criteria for reviews of cases. This role will work from our supported systems and take inbound calls from physicians or members regarding their pending, approved, or denied prior authorizations, internally support the Prior Auth team and member services department, as well as provide on-call after hours availability for urgent PA requests as needed.

Responsibilities

• Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design.
• Verify insurance coverage and eligibility, interpret clinical guideline criteria, consult physicians and other healthcare providers.
• Utilize clinical knowledge and resources while complying with department protocols.
• Guarantee that decisions regarding cases are conveyed promptly and efficiently to all healthcare providers, health plans/employers, patients, and other healthcare professionals.
• Collaborate with technicians and prior authorization team members to process referrals, answer clinical questions, and collect appropriate clinical/medical data.
• Handle inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients.
• Maintain professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs.
• Perform other related projects and duties as assigned, including attending training sessions and development meetings.

Qualifications

• Previous pharmacy experience in PBM preferred.
• Appropriate state license required.
• Basic computer skills required.
• Strong organizational skills, interpersonal skills, and detail orientation important for this position.

Requirements

• MUST HAVE MANAGED CARE experience and Medicare/Medicaid knowledge.
• MUST HAVE 6 months of experience with Prior Authorization (required).
• Must Have Pharmacy Benefit Management (PBM) experience.

Education

• Pharm D. required with at least two years experience as a pharmacist in a Managed care environment.

Licenses

• Must have an active Pharmacist license in the state of residence in good standing.

Company Description

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com .

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.