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Job ID 2104131
Job Description
Join our dynamic team as a Remote Pharmacist on a 12-month contract, where your expertise will play a pivotal role in supporting Medicare Part D members and healthcare providers with inquiries related to their pharmacy benefits. In this impactful position, you will ensure that member cases are accurately established and will review clinical information to assist in making informed decisions regarding their requests. Engaging directly with providers for additional information as necessary, you will uphold compliance with compendia and Medicare guidelines while working within established timelines.
This opportunity is an excellent entry point into the healthcare sector with a reputable company, where you’ll be instrumental in thoroughly reviewing requests and documenting results accurately to meet Medicare standards—all while delivering a top-notch service experience.
Key Responsibilities:
- Collaborate across various teams within CD&A, addressing clinical inquiries and gathering essential clinical and medical data to conduct assessments aligned with health plan or employer criteria, adhering to service level agreements. (20%)
- Ensure the timely dissemination of case decisions to physicians, health plans, patients, and other healthcare professionals, following established approval and denial management processes. (20%)
- Evaluate ongoing cases and deliver clinical decisions related to Prior Authorizations, Tier Exceptions, and Non-Formulary requests. (50%)
- Participate in additional projects and responsibilities as assigned, which may include on-call and after-hours pharmacist duties as required. (10%)
Qualifications:
- Valid Pharmacist License in your current state
- Experience in Prior Authorization processes
- Familiarity with Medicare regulations
- Background in healthcare settings
Skills:
- Proficient in Prior Authorization protocols
- Knowledgeable in Medicare systems
- Experienced in handling Prior Authorization calls
Education:
- Bachelor’s Degree in Pharmacy Required
- PharmD preferred, along with a valid Pharmacist License in your state of residence
About US Tech Solutions:
US Tech Solutions is a global leader in staff augmentation, offering a diverse array of talent-on-demand and comprehensive workforce solutions. Discover more about us at [US Tech Solutions website]. We pride ourselves on being an Equal Opportunity Employer, ensuring all qualified candidates are considered for employment without discrimination based on race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.