We are seeking a detail-oriented and experienced Pharmacist to join our team remotely, providing direct support to Medicare Part D members and providers with their pharmacy benefit requests. This role involves accurately setting up cases, reviewing clinical information, performing provider outreach, and ensuring compliance with Medicare guidelines and timelines. This position offers an excellent opportunity to begin a career with a leading healthcare company, emphasizing timely and accurate documentation and best-in-class service experiences.
Key Responsibilities
Clinical Support and Data Collection (20%)
Collaborate with multiple groups within Clinical Decision & Assessment (CD&A).
Answer clinical questions and collect necessary clinical/medical data for assessments.
Perform reviews as per health plan/employer criteria within designated service level agreements.
Case Decision Communication (20%)
Coordinate timely communication of case decisions to physicians, health plans/employers, patients, and other healthcare professionals.
Follow agreed-upon approval and denial management processes.
Clinical Decision Making (50%)
Review cases in progress and provide clinical decisions regarding prior authorizations, tier exceptions, and non-formulary requests.
Additional Duties (10%)
Perform related projects and duties as assigned, including potential on-call and after-hours availability.
Qualifications
Licensure: Licensed Registered Pharmacist in the state of residence.
Experience: Minimum of 1 year of experience required, although 2-5 years is preferred.
Education: Bachelor's Degree required; Pharm D preferred.
Technical Skills: Knowledge of Access, PowerPoint, and Visio is preferable. Must be computer literate with proficiency in Excel and Word.
Training And Work Schedule
Initial Training: Attendance is crucial during the initial 8 weeks of training. New hires must be available Monday to Friday from 9 am-5:30 pm EST,
Regular Hours: 8 am to 8 pm EST/CST, 8 hours per day, Monday to Friday.
Rotating Weekends: 7 am-3:30 pm EST/CST on rotating weekends.
Seniority level
Not Applicable
Employment type
Contract
Job function
Health Care Provider
Industries
Hospitals and Health Care, Mental Health Care, and Pharmaceutical Manufacturing
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