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)

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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