Remote Pharmacist (PBM Experience) REMOTE Prior Authorization

Cleveland, OH

Posted: 06/13/2024 Category: Pharmacy Job Number: KS120304

Job Description

Remote Pharmacist (PBM Experience) REMOTE Prior Authorization

The basic function of the pharmacist is to review and complete criteria based on prior authorization as per policy and procedure.

Please Contact: Katherine 586-710-0022 (call or text after you send your resume or apply to the job posting)

Start dates: August - December 

Pharmacist Schedule: 

  • Training M-F from 9am - 530pm EST for the first 8 weeks (no vacation time planned
  • Schedule 1: Mon-Fri 9:30am-6:00pm CT - Training will be Mon-Fri 8:00am-4:30pm CT
  • Schedule 2: 9am CST or later - 8 hours per day expected; Tuesday-Saturday or Sunday-Thursday, Training dates: October 2nd - October 10th, 2023; training time: 8am to 4:30pm CST

Pharmacist Experience Requirements:

  • Previous pharmacy experience in PBM (pharmacy benefit management) or experience adjudicating prior authorization for a PBM
  • Pharm D, Pharmacist, RPH state license in the state that you will be working required, license should be in good standing.
  • Bachelor's degree in pharmacy or Pharm D.
  • At least two years of experience as a pharmacist
  • Basic computer skills required.
  • Strong organizational skill, interpersonal skills and detail orientation important for this position.

Technical Requirements:

  • Must have a smart phone, VPN will be added to the smartphone.
  • Must have a private area in home to work.

Internet Speed:

  • Minimal home broadband connectivity speed of 25 Mb downloads and 3 MB upload speed.
  • Speed for home internet can be confirmed by going to www.speedtest.net. 

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 CVS Caremark, 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%)

Please Contact:

Katherine Skelton

586-710-0022

kskelton@alinestaffing.com

 

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