Prior Authorisation Clinical Pharmacist

Location:

Remote Duration: 2 Months Contract (with possible extension)
Job Description s

• Under the direction of the Pharmacy Utilization Management (UM) Supervisor, the Clinical Pharmacist is responsible for reviewing, processing and managing the daily caseload of pharmacy and medical prior authorization (PA) requests for coverage determinations and exceptions. The Clinical Pharmacist ensures timely disposition of PA reviews by adherence to established time frames. The Clinical Pharmacist consults as required with Medical Directors on prior authorization that fails to meet drug prior authorization (PA) criteria for coverage.

• Performs case reviews in automated prior authorization tools and guides the case through the entire process to either approval or denial to ensure all coverage determinations and notices are consistent with applicable regulatory and accreditation requirements and turnaround times
• Provides all aspects of clinical support needed to perform drug prior authorization (PA) requests and consults as required with Medical Directors on cases that fail to meet coverage criteria
• Communicates daily with providers and other external customers regarding status and disposition of cases
• Oversees and addresses any quality issues with pharmacy technicians and confer with other clinical pharmacist on review questions
• Communicate with UM staff and providers when issues arise regarding policy interpretation, potential access availability or other quality assurance issues to ensure that members receive coverage determinations within timelines developed by all accrediting and regulatory guidelines
• Performs other roles/duties and projects as assigned by the Pharmacy UM Supervisor(s)
• Must be a licensed pharmacist with good standing with Board of Pharmacy

• 3-5 years of experience as a Prior Authorisation Pharmacist in a managed care setting
• Utilization Management experience is required.

• Degree in Pharmacy or equivalent experience

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