vTech Solution
Pharmacist I - Prior Authorization
vTech Solution, Raleigh, North Carolina, United States, 27601
Duties:
As a licensed health care professional employed in the Pharmacy Prior Authorization Department your primary responsibility is to make determinations on prior authorization and coverage requests for pharmaceutical products. Determinations include medical necessity and benefit decisions. Decisions are made in accordance with established pharmacy guidelines, contract criteria, industry regulations and sound clinical judgment.The Prior Authorization pharmacist works independently with respect to reviews and decision making, with the support of senior pharmacist staff and supervisors. You will work as member of a team of peers committed to meeting or exceeding quality standards and customer performance guarantees. Additional responsibilities include:Telephonically provide clinical support to the PerformRx Contact CenterEngage providers in discussions to support determinationsSupport Fraud and Abuse program system oversight.Participate in various Pharmacy-related projectsKeep abreast of industry trends and regulatory changesKeep abreast of operational directives and customer reference materials
Skills:
2 years pharmacy experience preferred
Previous experience in managed care environment preferred
Education:
Current pharmacy license in North Carolina REQUIRED
Must Reside in North Carolina
Language:
English
Read
Write
Speak
(Read, Write, Speak) CLINICAL SUPPORT,PHARMACY,MANAGED CARE,PHARM D
Address:
8041 Arco Corporate DriveWork Performed OnSite:Reason Details:Start Date:
06/17/2024End Date:
10/15/2024Schedule Notes:
Monday- Friday 8:30am-5pm EST
As a licensed health care professional employed in the Pharmacy Prior Authorization Department your primary responsibility is to make determinations on prior authorization and coverage requests for pharmaceutical products. Determinations include medical necessity and benefit decisions. Decisions are made in accordance with established pharmacy guidelines, contract criteria, industry regulations and sound clinical judgment.The Prior Authorization pharmacist works independently with respect to reviews and decision making, with the support of senior pharmacist staff and supervisors. You will work as member of a team of peers committed to meeting or exceeding quality standards and customer performance guarantees. Additional responsibilities include:Telephonically provide clinical support to the PerformRx Contact CenterEngage providers in discussions to support determinationsSupport Fraud and Abuse program system oversight.Participate in various Pharmacy-related projectsKeep abreast of industry trends and regulatory changesKeep abreast of operational directives and customer reference materials
Skills:
2 years pharmacy experience preferred
Previous experience in managed care environment preferred
Education:
Current pharmacy license in North Carolina REQUIRED
Must Reside in North Carolina
Language:
English
Read
Write
Speak
(Read, Write, Speak) CLINICAL SUPPORT,PHARMACY,MANAGED CARE,PHARM D
Address:
8041 Arco Corporate DriveWork Performed OnSite:Reason Details:Start Date:
06/17/2024End Date:
10/15/2024Schedule Notes:
Monday- Friday 8:30am-5pm EST