Pharmacist - Remote
Contract W2
11 Months
No Travel Required
Remote
$47 - $52/hr
VIVA USA INC
Fitment
Dice Job Match Scoreβ’
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Job Details
Skills
- Microsoft Office
- Clinical Resources
- Prior Authorization
- Communication
- Organizational Skills
- reviewing prior authorizations
- processing prior authorizations
- clinical setting
- Micromedex
- Lexicomp
- Clinical Pharmacology
- call center
- clinical pharmacy
- Windows based computer applications
- web based processing
- telephony programs
- clinical guideline
- clinical knowledge
- approval management processes
- denial management processes
- Specialty Pharmacy programs
- Non-Specialty Pharmacy programs
- Commercial Prior Authorization
- Case Review Unit
- CRU
- clinical review
- pharmacist license
- pharmacy systems
- PBM
- managed care
- health plan
- specialty pharmacy
- computer skills
- documentation
- remote work
- insurance verification
Summary
ππ’ππ₯π: Pharmacist - Remote
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Microsoft Office, Clinical Resources, Prior Authorization, Communication, Organizational Skills,
reviewing prior authorizations, processing prior authorizations,
clinical setting,
clinical resources, Micromedex, Lexicomp, Clinical Pharmacology,
call center, clinical pharmacy,
Microsoft Office, Windows based computer applications, web based processing, telephony programs,
clinical guideline, clinical knowledge, clinical resources,
approval management processes, denial management processes,
Specialty Pharmacy programs, Non-Specialty Pharmacy programs, Commercial Prior Authorization, Case Review Unit, CRU,
prior authorization, clinical review, pharmacist license, pharmacy systems, PBM, managed care, health plan, specialty pharmacy, computer skills, documentation, communication, remote work, insurance verification,
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Position Summary
The Pharmacist/Clinician is an operation-based role that conducts criteria based & clinical review of medical data collected to perform prior authorization as per policy and procedure. The Pharmacist/Clinician will apply clinical knowledge to plan approved criteria for reviews of cases. This role will work from client supported systems and take inbound calls from physicians or members regarding their pending, approved, or denied prior authorizations, internally support the Prior Auth team and member services department, as well as provide on-call after hours availability for urgent PA request as needed.
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Duties
1.) Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design. Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols. One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval & denial management processes. (60%)
2.) Collaborates with the technicians and prior authorization team members to process referrals, including answering clinical questions and 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. Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations. (25%)
3.) Maintains professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered within the Commercial Specialty line of business.(10%)
4.) Performs other related projects and duties as assigned, including attending training sessions and development meetings, and providing on-call and after-hours pharmacist availability as needed.(5%)
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Experience
Previous pharmacy experience in PBM preferred. Appropriate state license required. Basic computer skills required. Strong organizational skill, interpersonal skills and detail orientation important for this position.
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Prior Work Experience:
Required: 1 to 3 years
Preferred: 3 to 5 years
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Education
Required: Bachelor's Degree - BS Pharmacy and an active pharmacist license in the state of practice/residence.
Preferred: Doctorate - Pharm D
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VIVA USA is an equal opportunity employer and is committed to maintaining a professional working environment that is free from discrimination and unlawful harassment. The Management, contractors, and staff of VIVA USA shall respect others without regard to race, sex, religion, age, color, creed, national or ethnic origin, physical, mental or sensory disability, marital status, sexual orientation, or status as a Vietnam-era, recently separated veteran, Active war time or campaign badge veteran, Armed forces service medal veteran, or disabled veteran. Please contact us at for any complaints, comments and suggestions.
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Account co-ordinator: Keerthana Bathrappan
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VIVA USA INC.
3601 Algonquin Road, Suite 425
Rolling Meadows, IL 60008
Employers have access to artificial intelligence language tools (βAIβ) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
- Dice Id: vivausa
- Position Id: KBRIPR14
- Posted 5 hours ago
Company Info
VIVA is an Information Technology Management and Consulting services company with offices in the US and India.
Formed by some of the industry's most experienced and knowledgeable people, VIVA is growing to be one of the best-managed consulting companies in the world. VIVA has established itself as a reliable supplier of IT services. We specialize in IT staff augmentation, On-site and Off-site IT consulting, Turnkey Project Outsourcing, and eBusiness Solutions. Our software professionals have successfully worked on many on-site and off-site IT consulting engagements across the US.
Our business focus includes areas of on-site, off-site and offshore information technology consulting services and software development.
The software development centers in our corporate office at Rolling Meadows, IL and at Chennai, India are well equipped to undertake software development, maintenance and conversion activities.
VIVA has associated itself with leading software vendors such as Microsoft, Rational and COGNOS. VIVA is a Rational Unified Partner, a Microsoft Certified Solution Provider and a COGNOS premier partner.
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