A-Line Staffing is now hiring REMOTE PBM Prior Authorization Pharmacist! The REMOTE PBM Prior Authorization Pharmacist would be working for a Fortune 500 company and has career growth potential. This would be full time / 40+ hours per week.
Benefits are available to full-time employees after 90 days of employment and include health, optical, dental, life, and short-term disability insurance
A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates
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 supported systems and take inbound calls from physician or members regarding their pending approved or denied prior authorizations.
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 healthplan/employer agreed criteria within the designated service level agreements.
Coordinates timely communication of case decision to physician health-plan/employer patient and other healthcare professionals following agreed upon approval denial management processes.
Handles inbound phone calls and escalations from physicians or patients regarding Prior Authorization.
Maintain professional and technical knowledge of drug and disease-states for the Specialty Pharmacy programs administered within the Case Review Unit
1 year of recent experience with PBM prior authorization
Active and in good standing Pharmacist license in the state in which you sit
Attendance is mandatory for the first 90 days
If you think this REMOTE PBM Prior Authorization Pharmacist position is a good fit for you, please reach out to me - feel free to call, e-mail, or apply to this posting!
Seniority level
Entry level
Employment type
Full-time
Job function
Health Care Provider
Industries
Staffing and Recruiting
Referrals increase your chances of interviewing at RemoteWorker US by 2x