Job Description:
Job Description:Overview
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; and support Customer Care with clinical calls requiring pharmacist intervention. The Pharmacist I, Clinical Prior Authorization is also responsible for interfacing with physicians, pharmacists, and specialty pharmacy providers with respect to beneficiaries’ benefits and therapeutic interventions, and reviewing/evaluating the health surveys and utilization data for program management and development.
Is this you? Find out more below!
Responsibilities
How do I make an impact on my team? Responsible for support and input to clinical programs such as: Health Management, Drug Utilization Review, Formulary development, and Prior Authorization programs to encourage appropriate, high quality, cost effective drug therapy; and to identify opportunities for improvement in efficiency, accuracy, and appropriateness of the programs in placeParticipate in the Coverage Determination (Certification, Prior Authorization, Medical Exception, Exception to Coverage, etc.) process be reviewing all requests which are not clearly approvable based on specified criteria (algorithms), making all coverage denial determinations, and identifying themselves by first name, title, and responsibility at Navitus in relation to drug utilization management program administrationContinually monitor the quality and efficiency of the Coverage Determination process including coverage criteria, denial language, and communication with prescribersProvide input to clinical content of new programs and for maintenance of existing programsComplete all annual URAC training requirementsFacilitation of communication and education to clients, members, and internal staff regarding clinical daily issues and objectivesProvide support to operational departments on the implementation of various PBM programs and daily functioning in support of member/patient quality of careResponsible for supporting / providing clinical expertise related to formulary decisions made by the Pharmacy and Therapeutics committeeMay 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 interactionOther duties as assigned
Qualifications
What our team expects from you? 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, may be required based on state of residence laws or client contracts. Other State Pharmacy Licenses may be required as business need dictates. Must continually maintain education credits to maintain active licensure.Two years’ work experience in a clinical setting, or clinical or managed care pharmacy practice residency preferredKnowledge of PBM industry, formulary management, pharmacy claims and managed care principles and practices desiredExceptional clinical skills and ability to apply sound clinical judgment to a variety of situations is necessaryProficiency in drug literature and clinical trial evaluation, including proficiency with electronic databases (e.g., Micromedex, Medline, Internet) preferredAbility to reason and translate clinical information into a manner appropriate for clinical systems and clinical/non-clinical audiencesEmphasis on problem-solving skills, including identifying and accepting a challenging situation and creating and implementing a solutionRequires attention to details to assure projects are clinically, editorially, and systems accurate and can be operationalizedProficiency in MS Word, Excel, Power Point including tables, charts and figures preferredParticipate in, adhere to, and support compliance program objectivesThe ability to consistently interact cooperatively and respectfully with other employees
What can you expect from Navitus? 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!
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Navitus Health Solutions is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by law.
Equal employment opportunity, including veterans and individuals with disabilities.
PI288226657
Salary:
$101,335.00
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