𝐓𝐢𝐭𝐥𝐞: Pharmacist - Remote
𝐌𝐚𝐧𝐝𝐚𝐭𝐨𝐫𝐲 𝐬𝐤𝐢𝐥𝐥𝐬:
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,
𝐃𝐞𝐬𝐜𝐫𝐢𝐩𝐭𝐢𝐨𝐧:
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.
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%)
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.
Prior Work Experience:
Required: 1 to 3 years
Preferred: 3 to 5 years
Education
Required: Bachelor's Degree - BS Pharmacy and an active pharmacist license in the state of practice/residence.
Preferred: Doctorate - Pharm D
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.
𝐂𝐨𝐧𝐭𝐚𝐜𝐭 𝐃𝐞𝐭𝐚𝐢𝐥𝐬 :
Account co-ordinator: Keerthana Bathrappan
VIVA USA INC.
3601 Algonquin Road, Suite 425
Rolling Meadows, IL 60008
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