Job Description

Job Description

Job Description

A-Line Staffing Solutions is looking to hire a REMOTE PBM Prior Authorization Pharmacist with a major healthcare company. Starting ASAP!!

If this the position for you, apply to Andrew at [email protected] for immediate consideration!!!

PBM Prior Authorization Pharmacist Compensation: $53.00 p/hr

Hours: full-time 8 hours per day 40 hours per week - possible weekends included

What does the PBM Prior Authorization Pharmacist do?

• Operation based role that conducts clinical reviews of medical data collected to perform prior authorization for specialty medications
• Will apply clinical knowledge to plan approved criteria for prospective and concurrent reviews of cases
• This role will work from supported systems and take inbound calls from physicians or members regarding their pending, approved, or denied prior authorizations
• Coordinates timely communication of case decision to physician, health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes
• Handles inbound phone calls and escalations from physicians or patients regarding Prior Authorization
• 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

PBM Prior Authorization Pharmacist Qualifications/Requirements:

• 3+ years experience is preferred
• PBM pharmacy experience
• Experience making decision with prior authorizations
• Active Pharmacist license with no restrictions
• Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable. Keyboard skills essential

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