Position will be halted until September 4th. Do not submit candidates until September 4th.
A broadband connection and a smartphone are required. Please list internet speed on resume. Candidates can work from anywhere in the continental U.S. with the exclusion of New Mexico and Colorado candidates.
Shift start time: 9am CST or later - 8 hours per day expected; Tuesday-Saturday or Sunday-Thursday
Training dates: October 30th - November 7th, 2023; training time: 8am to 4:30pm CST
Clinical Pharmacist Position Summary
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. This role will work from CVS Caremark supported systems and take inbound calls from physicians or members regarding their pending, approved, or denied prior authorizations.
Responsibilities
Collaborates with the CRU Technician to process referrals, 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. (30%)
Coordinates timely communication of case decision to physician, health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes. (30%)
Handles inbound phone calls and escalations from physicians or patients regarding Prior Authorization (25%)
Establishes and maintains communication among health plan and employer group staff. (5%)
Maintain professional and technical knowledge of drug and disease-states for the Specialty Pharmacy programs administered within the Case Review Unit. (5%)
Performs other related projects and duties as assigned including on call and after hours pharmacist availability could be required. (5%)
Shift start time: 9am CST or later; Tuesday-Saturday or Sunday-Thursday
Licensed Registered Pharmacist
Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable. Keyboard skills essential.
Must be able to multitask and utilize multiple system applications simultaneously.
Must be able to utilize available resources independently and provide high quality work.
Must be able to absorb presented information, display motivation, seek development and problem solve.
Ability to adapt and change with workflow and shifting priorities.
Must possess excellent written, verbal, grammar, and listening communication skills.
Must be able to deal with a diverse customer base (internal and external) in a friendly and confident manner.
Ability to maintain confidentiality of PHI (Protected Healthcare Information).
3+ years experience is preferred.
This is a safety sensitive position. Completion of all screens is required prior to the candidate starting the assignment. Upon acceptance please send the following information: A broadband connection and a smartphone are required. The VPN token will be need to be downloaded to the user's smartphone. NOTE: They can work from anywhere in the continental U.S. with the exclusion of New Mexico and Colorado candidates.
Job Posting Number of Positions
40
Site
_OffSite (HOME)
Cost Center List
293028 - Specialty PA RAMP
Supplier
Additional Details
Is this request for Peak Season? Select applicable value : RAMP - Clinical Commercial
Duties : Answer phone lines promptly with priority on 'Pharmacist' line and escalated calls. Serves as the final decision-maker on all PA denials. Works distributed faxes. Maintains accurate documentation of calls. Works all client exceptions. Maintains and updates all desk references materials. Assures the proper processing and maintenance of all PA paperwork. Attends on going training and development meetings.
Experience : Prior authorization experience preferred. 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.
Position Summary : The basic function of the pharmacist is to review and complete criteria based prior authorization as per policy and procedure and provide internal pharmacist support to the PA team and member services department.
Education : Bachelor's degree in pharmacy or Pharm D. Must have an active license in the state of work.
What days & hours will the person work in this position? List training hours, if different. : Shift start time: 9am CST or later; Tuesday-Saturday or Sunday-Thursday