[Hiring] Pharmacist @ICONMA

Role Description

Our Client, a Retail Pharmacy company, is looking for multiple Pharmacists with prior authorization experience to work remotely.

• 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, and 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 following agreed-upon approval & denial management processes.
• Collaborate with technicians and prior authorization team members to process referrals, including answering clinical questions and collecting appropriate clinical/medical data needed to perform clinical assessments and reviews as per the health plan/employer-agreed criteria within designated service level agreements.
• Perform and handle inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations.
• Maintain professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered within the Commercial Prior Authorization and Case Review Unit (CRU) line of business.
• 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.
• Demonstrated experience using clinical resources, e.g., Micromedex, Lexicomp, Clinical Pharmacology.
• Ability to prioritize, quickly assess, manage multiple tasks, and adapt to constantly changing situations.

Qualifications

• Excellent organizational skills.
• Strong detail orientation.
• Strong Microsoft Office skills.
• Ability to receive phone calls from prior authorization pharmacy technicians and/or providers for clinical information.
• Minimum 2 years’ recent experience reviewing and processing prior authorizations against health plan criteria for a determination in a specialty/skilled clinical setting (e.g., specialty medical office or Pharmacy Benefits Manager).
• Bachelor’s degree in pharmacy or PharmD.

Benefits

• Health Benefits.
• Referral Program.
• Excellent growth and advancement opportunities.

Company Description

ICONMA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to any status protected by applicable law.