Job Overview
Join a dynamic and expanding remote team as a licensed pharmacist, where you will have the opportunity to significantly contribute to the healthcare sector. In this pivotal role, your primary focus will be on evaluating prior authorization requests and making informed coverage determinations aligned with clinical guidelines and plan specifications. You will be instrumental in ensuring that patients receive appropriate medications and services while adhering to established protocols and standards.
Key Responsibilities
- Assess and analyze prior authorization requests, confirming insurance coverage and eligibility while interpreting clinical guidelines.
- Collaborate with physicians and healthcare providers to facilitate accurate decision-making processes.
- Promptly manage and communicate approval or denial decisions to healthcare providers, health plans, patients, and other relevant professionals.
- Assist Medicare Part D members and providers with pharmacy benefit inquiries.
- Conduct comprehensive reviews of clinical data, engaging with providers when necessary to ensure compliance with Medicare guidelines and timelines.
- Maintain accurate and timely documentation of all Medicare Part D requests.
Required Skills
- Must hold a valid pharmacist license in the state of residence.
- Prior authorization experience in a Pharmacy Benefit Management (PBM) environment is essential; retail pharmacy experience is not relevant.
- Ability to operate effectively from a home office environment that is quiet and free from distractions, with a reliable internet connection and Ethernet access.
Qualifications
- Must be a licensed pharmacist in the state of employment.
- Prior authorization experience in a PBM setting is required.
Career Growth Opportunities
This role presents a unique opportunity to advance your career within a highly regarded healthcare organization, where you can support essential services while working remotely in a nurturing environment. Opportunities for professional development and upward mobility within the organization are available as you contribute to improving patient care.
Compensation And Benefits
Hourly Pay Rate: \(51.58 - \)53.00 per hour (based on role assignment)
Shifts Available
- Option 1: Monday - Friday, 8:00 AM - 8:00 PM EST/CST (8 hours per day) or rotating weekends (7:00 AM - 3:30 PM EST/CST)
- Option 2: Monday - Friday, 9:30 AM - 6:00 PM EST/CST
- Option 3: Sunday - Thursday or Tuesday - Saturday, shifts from 10:30 AM - 7:00 PM CST, 11:00 AM - 7:30 PM CST, or 11:30 AM - 8:00 PM CST
If you are dedicated to making a difference in the lives of others and are seeking a flexible and impactful remote position, we invite you to apply!
Employment Type: Full-Time
