Pharmacist I - Prior Authorization

Duties:   
• As a licensed health care professional employed in the Pharmacy Prior Authorization Department your primary responsibility is to make determinations on prior authorization and coverage requests for pharmaceutical products.
• Determinations include medical necessity and benefit decisions.
• Decisions are made in accordance with established pharmacy guidelines, contract criteria, industry regulations and sound clinical judgment. 
• The Prior Authorization pharmacist works independently with respect to reviews and decision making, with the support of senior pharmacist staff and supervisors.
• You will work as member of a team of peers committed to meeting or exceeding quality standards and customer performance guarantees.

Additional responsibilities include:
• Telephonically provide clinical support to the PerformRx Contact Center
• Engage providers in discussions to support determinations
• Support Fraud and Abuse program system oversight.
• Participate in various Pharmacy-related projects
• Keep abreast of industry trends and regulatory changes
• Keep abreast of operational directives and customer reference materials

Skills:   
2 years pharmacy experience preferred.
•Previous experience in managed care environment preferred

Education:   
• Current pharmacy license, Commonwealth of Pennsylvania preferred. Pharm D. preferred.

Languages:   
• English: Read,   Write, Speak

Certifications & Licenses:   
• Current pharmacy license, Commonwealth of Pennsylvania preferred. Pharm D. preferred.

Skills:     
Required
• CLINICAL SUPPORT
• MANAGED CARE
• PHARMACY
• PHARM D

Additional
Minimum Degree Required:   
• Professional (J.D., M.D., D.D.S. or Pharm. D.)

Reach Out to a Recruiter


  • : asimk@vtechsolution.us