[Hiring] Pharmacist I, Clinical Prior Authorization @Navitus Health Solutions, LLC

Role Description

Due to growth, we are adding a Pharmacist I, Clinical Prior Authorization to our team!

The Pharmacist I, Clinical Prior Authorization will be responsible for:

• Performing Prior Authorizations
• Perform duties related to Drug Utilization Review including concurrent, retrospective, and prospective components
• Support Customer Care with clinical calls requiring pharmacist intervention
• Interfacing with physicians, pharmacists, and specialty pharmacy providers regarding beneficiaries’ benefits and therapeutic interventions
• Reviewing/evaluating health surveys and utilization data for program management and development

Responsibilities

• Responsible for support and input to clinical programs such as Health Management, Drug Utilization Review, Formulary development, and Prior Authorization programs
• Identify opportunities for improvement in efficiency, accuracy, and appropriateness of the programs in place
• Participate in the Coverage Determination process by reviewing all requests which are not clearly approvable based on specified criteria
• Make all coverage denial determinations and identify themselves by first name, title, and responsibility at Navitus
• Continually monitor the quality and efficiency of the Coverage Determination process
• Provide input to clinical content of new programs and for maintenance of existing programs
• Complete all annual URAC training requirements
• Facilitate communication and education to clients, members, and internal staff regarding clinical daily issues and objectives
• Provide support to operational departments on the implementation of various PBM programs
• Responsible for supporting/providing clinical expertise related to formulary decisions made by the Pharmacy and Therapeutics committee
• May review health care survey data for Medicare Part D qualified participants
• Perform phone consultations with Med-D enrollees; aid in documentation of calls
• Designate enrollees for repeat interaction
• Other duties as assigned

Qualifications

• A minimum of a bachelor’s degree in Pharmacy or Pharm D
• Current, unrestricted licensure as a Registered Pharmacist in the state of residence
• Two years’ work experience in a clinical setting, or clinical or managed care pharmacy practice residency preferred
• Knowledge of PBM industry, formulary management, pharmacy claims and managed care principles and practices desired
• Exceptional clinical skills and ability to apply sound clinical judgment
• Proficiency in drug literature and clinical trial evaluation
• Ability to reason and translate clinical information for clinical systems and audiences
• Emphasis on problem-solving skills
• Requires attention to detail
• Proficiency in MS Word, Excel, Power Point preferred
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

Benefits

• Top of the industry benefits for Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5% - No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program – up to $750!