NEW JOB OPENING PHARMACIST OPERATIONS ADVISOR IN REMOTE, USA!

Job Description

Required Education

• Bachelor's Degree - BS Pharmacy
• Active pharmacist license in the state of practice/residence.

Preferred Education

• Doctorate - PharmD.

Required License/Certification

• Active pharmacist license.

Required Qualifications/Skills/Experience

• Prior experience with prior authorization (PA) reviews or clinical case review in a high-volume or production setting
• Direct experience processing PA requests, ideally with a commercial or specialty pharmacy
• Strong documentation of meeting service level agreements (SLAs) or production targets
• Ability to multitask using multiple technology platforms and clinical resources
• Proficiency with Microsoft Office (Excel and Word)
• Experience using multiple clinical and administrative systems simultaneously
• Effective written and verbal communication skills
• Ability to collaborate with cross-functional clinical and non-clinical staff
• Comfort handling phone-based interactions with providers and patients.

Preferred Qualifications/Skills/Experience

• Retail pharmacy experience (not required, but candidates with this background have been successful in the role).

Pharmacist/Clinician Overview

• Operation-based role that conducts criteria-based and clinical review of medical data for prior authorization in alignment with policy and procedure
• Applies clinical knowledge to plan and approve criteria for case reviews
• Works within Client-supported systems to handle inbound calls from physicians or members regarding pending, approved, or denied prior authorizations
• Provides internal support to the Prior Authorization team and the Member Services department
• Provides on-call, after-hours availability for urgent prior authorization requests as needed
• Position is remote, available to candidates anywhere in the continental U.S. except New Mexico and Colorado
• Requires a broadband internet connection and a smartphone

Job Duties

• Evaluate and review prior authorization requests, render coverage determinations based on clinical criteria, and plan design
• Verify insurance coverage and eligibility, interpret clinical guideline criteria, and consult with healthcare providers
• Communicate approval and denial decisions promptly to providers, employers, patients, and other stakeholders
• Collaborate with technicians and team members to process referrals, answer clinical questions, and collect required data
• Handle inbound/outbound calls to facilitate requests, answer inquiries, and resolve escalations
• Maintain professional and technical knowledge of drug and disease states for specialty and non-specialty programs
• Attend training sessions, development meetings, and provide after-hours/on-call support as required
• Perform other related duties as assigned.

Essential Functions

• Regular and predictable attendance
• Ability to work mandatory overtime or extended work weeks as needed
• Compliance with departmental, company, state, and federal requirements
• Adherence to policies and procedures
• Ongoing participation in training and development meetings.
• Only those lawfully authorized to work in the designated country associated with the position will be considered.

• Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client's business needs and requirements. Benefits: For information and details on employment benefits offered with this position, please visit here . Should you have any questions/concerns, please contact our HR Department via our secure website . California Pay Equity: For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations' website here . Rose International is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender (expression or identity), national origin, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances. If you need assistance in completing this application, or during any phase of the application, interview, hiring, or employment process, whether due to a disability or otherwise, please contact our HR Department . Rose International has an official agreement (ID #132522), effective June 30, 2008, with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). (Posting required by OCGA 13/10-91.). Apply tot his job Apply To this Job