Pharmacist – RPh Operations Advisor – Specialty Medical Prior Authorization Aetna

Job Title: Clinical Pharmacist Advisor – Specialty Medical Prior Authorization
Location: Remote
Duration: 6+ months contract

Job Description:

• The clinical pharmacist is an operation based role that conducts clinical reviews of medical data collected to perform prior authorization for specialty medications.
• The clinical pharmacist will apply clinical knowledge to plan approved criteria for prospective and concurrent reviews of cases.
• Support systems and take inbound calls from physician or members regarding their pending, approved, or denied prior authorizations.

Responsibilities:

• Collaborating with Technicians and Nurses to process authorization requests, including answering clinical questions, collecting appropriate clinical/medical data needed to perform clinical assessments, and reviews as per the health plan/employer agreed criteria within the designated service level agreements. (20%)
• Coordinating timely communication of case decision to physician, health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes. (15%)
• Handling inbound phone calls and escalations from physicians or patients regarding Prior Authorization (50%)
• Establishing and maintaining communication among the company, health plan and employer group staff. (5%)
• Maintaining professional and technical knowledge of drug and disease-states for the Specialty Medical programs administered within the Novologix platform. (5%)
• Performing other related projects and duties as assigned. On call and after hours pharmacist availability may be required. (5%)

Experience:

• Prior authorization experience required.
• Previous pharmacy experience in retail or hospital preferred.
• Appropriate state license required. Basic computer skills required.
• Strong organizational skill, interpersonal skills and detail orientation important for this position.

Skills:

• Minimum of 2-5 years experience is preferred. Experience using MS Office and other Windows based computer applications, strong organizational skills, interpersonal skills, and detail orientation are important for this position.

• Required certification: Active pharmacist license in state of residence in good standing

Education:

• Pharm D. required with at least two years experience as a pharmacist in Managed care environment.
• Must have an active license in the state of residence in good standing.

Questionnaire:

• How many years of prior-authorization experience do you have?
• Haw many Prior Auth cases have you handled in your last role?
• Do you have experience in handling calls regarding prior authorization and appeals?

About US Tech Solutions:

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com.

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.