Medix
Pharmacist (Prior Authorization)
Medix, New York, New York, us, 10261
Company:
One of NY's largest Health Plans that focuses on Medicare and Medicaid Populations.
Duration:
July - end of August
***No significant time off requests are allowed during assignment, from now until end of August.
Requirements:
- Must have an active NY Pharmacist license in good standing today
- REMOTE - can sit anywhere as long as they have NY Pharmacy license
Hiring Manager Summary:
Candidate to conduct prior authorizations on medical benefit drugs aka J-Codes.
Ideal Candidate Profile:
- NY licensed Pharmacist with experience completing Prior Authorizations on behalf of a Health Plan.
- Utilization Management experience
- This is for their Specialty Pharmacy team, so a Pharmacist that might have worked in a hospital specifically an oncology/cancer or Specialty Pharmacy could potentially work.
Pay Rate:
$60-65/hr (negotiable)
Schedule:
Monday - Friday, either 8 to 5 or 9 to 6.
The Clinical UM Pharmacist is a dynamic position responsible for the review of prior authorizations for medications requested under the medical benefit. Additionally, the Clinical UM Pharmacist is responsible for developing clinical criteria, medical policies for provider administered medications, review of monthly report for quality assurance, and staying current with literature, evidence-based medicine, and trends in medicine. The Clinical Pharmacist works directly with prescribing physicians and Medical Directors to discuss clinical rationale for review decisions.
Duties & Responsibilities:Monitor and review prior authorization requests for medicationsCalculate appropriate billable units based on dosing, indication, weight, BMI and other clinical considerationsDevelop clinical criteria and medical policies for the review of medicationsEnsure all clinical criteria is in compliance with Center of Medicare and Medicaid Services (CMS) and the New York State Department of Health (NYSDOH)Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviewsEnsure prior authorization reviews are conducted in timeframes set forth by CMS and/or NYSDOHWork across departments as needed to complete Utilization Management reviewsReview monthly reports and provide feedback on trends, ideas for efficiency, and innovationAbility to work well in a team environment and be a team playerAdditional duties as assigned or requiredMinimum Qualifications:
Pharmacy degree from an accredited school of pharmacyRegistered Pharmacist with NY state license in good standing.Work experience conducting prior authorization reviewsClinical knowledge of pharmaceuticals and disease states in order to conduct prior authorization reviewsWork experience requiring written and verbal clinical communication that is clear, concise, grammatically correct, and professionalKnowledge of specialty pharmaceuticals and billing practices in the medical and pharmacy benefitsPreferred Qualifications:
PGY1 Managed Care ResidencyKnowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to National and Local Coverage DeterminationsDemonstrated critical thinking and problem-solving skillsPassion for learning, promoting the profession of pharmacy, and interest in growing skills in a dynamic environment with various opportunitiesExperience leading large and small working meetingsPC Skills with Microsoft Outlook, Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables)
One of NY's largest Health Plans that focuses on Medicare and Medicaid Populations.
Duration:
July - end of August
***No significant time off requests are allowed during assignment, from now until end of August.
Requirements:
- Must have an active NY Pharmacist license in good standing today
- REMOTE - can sit anywhere as long as they have NY Pharmacy license
Hiring Manager Summary:
Candidate to conduct prior authorizations on medical benefit drugs aka J-Codes.
Ideal Candidate Profile:
- NY licensed Pharmacist with experience completing Prior Authorizations on behalf of a Health Plan.
- Utilization Management experience
- This is for their Specialty Pharmacy team, so a Pharmacist that might have worked in a hospital specifically an oncology/cancer or Specialty Pharmacy could potentially work.
Pay Rate:
$60-65/hr (negotiable)
Schedule:
Monday - Friday, either 8 to 5 or 9 to 6.
The Clinical UM Pharmacist is a dynamic position responsible for the review of prior authorizations for medications requested under the medical benefit. Additionally, the Clinical UM Pharmacist is responsible for developing clinical criteria, medical policies for provider administered medications, review of monthly report for quality assurance, and staying current with literature, evidence-based medicine, and trends in medicine. The Clinical Pharmacist works directly with prescribing physicians and Medical Directors to discuss clinical rationale for review decisions.
Duties & Responsibilities:Monitor and review prior authorization requests for medicationsCalculate appropriate billable units based on dosing, indication, weight, BMI and other clinical considerationsDevelop clinical criteria and medical policies for the review of medicationsEnsure all clinical criteria is in compliance with Center of Medicare and Medicaid Services (CMS) and the New York State Department of Health (NYSDOH)Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviewsEnsure prior authorization reviews are conducted in timeframes set forth by CMS and/or NYSDOHWork across departments as needed to complete Utilization Management reviewsReview monthly reports and provide feedback on trends, ideas for efficiency, and innovationAbility to work well in a team environment and be a team playerAdditional duties as assigned or requiredMinimum Qualifications:
Pharmacy degree from an accredited school of pharmacyRegistered Pharmacist with NY state license in good standing.Work experience conducting prior authorization reviewsClinical knowledge of pharmaceuticals and disease states in order to conduct prior authorization reviewsWork experience requiring written and verbal clinical communication that is clear, concise, grammatically correct, and professionalKnowledge of specialty pharmaceuticals and billing practices in the medical and pharmacy benefitsPreferred Qualifications:
PGY1 Managed Care ResidencyKnowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to National and Local Coverage DeterminationsDemonstrated critical thinking and problem-solving skillsPassion for learning, promoting the profession of pharmacy, and interest in growing skills in a dynamic environment with various opportunitiesExperience leading large and small working meetingsPC Skills with Microsoft Outlook, Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables)