Job Description
National leading healthcare company is hiring Prior Authorization pharmacists for a remote role.
7am to 10pm CST - 8 hours/day
Training: M-F 8-4:30PM CST for 6 weeks
*Possible weekend shifts*
Position Summary: The clinical pharmacist is an operation based role that conducts clinical reviews of medical data collected to perform prior authorization for specialty medications. The clinical pharmacist will apply clinical knowledge to plan approved criteria for prospective and concurrent reviews of cases. This role will take inbound calls from physician or members regarding their pending, approved, or denied prior authorizations.
This individual must have excellent interpersonal skills. Will be responsible for:
1. Collaborates with the Technicians and Nurses to process authorization requests, 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. (20%)
2. Coordinates timely communication of case decision to physician, health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes. (15%)
3. Handles inbound phone calls and escalations from physicians or patients regarding Prior Authorization (50%)
4. Establishes and maintains communication among health plan and employer group staff. (5%)
5. Maintain professional and technical knowledge of drug and disease-states for the Specialty Medical programs administered. (5%)
6. Performs other related projects and duties as assigned including on call and after hours pharmacist availability could be required. (5%)
2+ years of clinical experience with *specialty medications* or *clinical review of prior authorization requests*.
Experience using MS Office and other Windows based computer applications, strong organizational skills, interpersonal skills, and detail orientation are important for this position.
Required certification: Active pharmacist license in state of residence in good standing
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Job Tags
Temporary work, Work experience placement, Shift work, Weekend work