Job Overview
We are seeking a committed and empathetic RPh Advisor to become a vital member of our team! In this pivotal role, you will be responsible for evaluating and processing prior authorization requests, ensuring informed coverage determinations based on established clinical criteria and plan design.
Key Responsibilities
- Review prior authorization requests with an emphasis on confirming insurance coverage and eligibility.
- Analyze clinical guidelines while collaborating with healthcare providers and physicians to effectively leverage your clinical expertise.
- Communicate coverage decisions promptly to healthcare providers, health plans, employers, patients, and other relevant professionals, adhering to our defined approval and denial management protocols.
- Offer direct assistance to Medicare Part D members and their providers regarding pharmacy benefits.
- Meticulously set up cases for members and evaluate clinical data to make sound decisions regarding requests.
- Reach out to providers for additional information as needed, ensuring compliance with pertinent compendia and Medicare standards.
- Accurately document all Medicare Part D requests in a timely manner, maintaining adherence to Medicare regulations while fostering a premier service experience for our members.
Required Skills
- A valid Pharmacist license within your state of residence.
- Prior authorization experience in Pharmacy Benefit Management (PBM) is preferred; retail experience is not relevant.
- A suitable home office environment that facilitates focused work and includes a dependable Ethernet connection.
Qualifications
- Bachelor's degree in Pharmacy or a related discipline.
- Proven experience in a licensed pharmacist capacity within the healthcare sector.
Career Growth Opportunities
Joining our esteemed organization offers significant potential for career advancement within the healthcare landscape, as you contribute to excellence in member support and service.
Company Culture And Values
Our organization is dedicated to positively impacting the lives of our members. We promote a collaborative and supportive environment where compassionate service is fundamental to our mission.
Compensation And Benefits
- A comprehensive benefits package will be available to full-time employees following 90 days of employment.
- A 401(k) plan with company matching is accessible to full-time employees after one year of service, aligning with our eligibility criteria.
By joining us, you can make a meaningful difference in the healthcare journey of our members, utilizing your clinical knowledge to enhance patient care.
Employment Type: Full-Time
