Pride Health is hiring for a Prior Authorization Pharmacist in MST/PST timezones! (Remote)
*Candidates must reside in MST/PST states*
Schedule: 5 days per week (must have weekend availability), must have availability as early as 5am and as late as midnight, includes scheduled overtime and working on holidays
Pay Rate: $54-60/hour
Type: Contract to permanent
Primary Responsibilities:
- Decisioning and processing member prescriptions or prior authorizations through various computer systems ensuring the accuracy of all data and updating as necessary
- Work is computer based and include receiving phone calls from prior authorization pharmacy technicians and/or providers for clinical information
- Consult physicians/providers with questions, interpret clinical guideline criteria, and render/review coverage determination for prior authorization cases
- Consult with pharmacy technicians and/or physicians regarding use of medications and advise of appropriate formulary alternatives when requested.
- Gather complex clinical information, coverage policy and criteria information and work within regulatory guidelines to make coverage determinations
- Organize workload, sets priorities, completes assignments in a timely manner and utilizes resources appropriately while complying with department program standards
- Perform all duties and functions in compliance with state and federal pharmacy laws and regulations
- Conform with and supports department quality assurance and improvement guidelines
- Dedication to build rapport with coworkers, internal customers, and other departments by demonstrating a strong customer service orientation and a continuous positive image
- Demonstrate ability to maintain productive working relationships with team members, other internal and external customers, and management team.
- Safety is paramount and it’s important for employees to have a safe and secure workspace and communicate with their leadership when that safety (equipment, system, information) is compromised.
Required Qualifications:
- Pharmacist license in good standing in current state
- Prior Authorization experience
Apply with Pride Health for this opportunity!
Pride Global offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.
