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

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.
• Performing duties related to Drug Utilization Review including concurrent, retrospective, and prospective components.
• Supporting 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.
• Participate in the Coverage Determination process by reviewing all requests which are not clearly approvable based on specified criteria, making coverage denial determinations, and identifying themselves by first name, title, and responsibility.
• Continually monitor the quality and efficiency of the Coverage Determination process including coverage criteria, denial language, and communication with prescribers.
• 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 and daily functioning in support of member/patient quality of care.
• 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 and/or 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, or the ability to gain reciprocity within 4 months.
• 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 to a variety of situations.
• Proficiency in drug literature and clinical trial evaluation, including proficiency with electronic databases (e.g., Micromedex, Medline, Internet) preferred.
• Ability to reason and translate clinical information into a manner appropriate for clinical systems and clinical/non-clinical audiences.
• Emphasis on problem-solving skills, including identifying and accepting a challenging situation and creating and implementing a solution.
• Requires attention to details to assure projects are clinically, editorially, and systems accurate and can be operationalized.
• Proficiency in MS Word, Excel, Power Point including tables, charts and figures 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!