Job Overview
We are seeking a dedicated and licensed pharmacist to join our esteemed organization as an RPh Advisor. In this pivotal remote role, you will play a critical part in evaluating and processing prior authorization requests, utilizing your clinical expertise to make informed coverage determinations. Your contributions will be essential in ensuring that our members receive the pharmacy benefits they deserve.
Key Responsibilities
- Verify insurance coverage and eligibility.
- Interpret clinical guideline criteria accurately.
- Consult with physicians and other healthcare professionals.
- Leverage your clinical knowledge while adhering to departmental protocols.
- Communicate decisions regarding cases promptly and effectively to healthcare providers, health plans/employers, patients, and other relevant professionals.
- Accurately set up cases for our members.
- Review clinical information to support decision-making.
- Reach out to providers for additional information as necessary.
- Ensure compliance with compendia and Medicare guidelines while completing all decisions within required timelines.
Required Skills
- Must possess a valid pharmacist license in your state of residence.
- Prior authorization experience within a Pharmacy Benefit Manager (PBM) setting is required (retail experience is not applicable).
- Strong communication skills for effective collaboration with healthcare providers.
- Ability to interpret clinical guideline criteria and provide informed consultations.
Qualifications
- A Doctor of Pharmacy (PharmD) or equivalent degree is required.
- Proven experience in prior authorization within a PBM setting is mandatory.
- A dedicated home office space that supports a distraction-free work environment, including a wired internet connection.
Career Growth Opportunities
This role presents an exceptional opportunity to advance your career in a leading healthcare organization. You will engage with significant clinical data, ensuring timely and precise documentation of all Medicare Part D requests while delivering exemplary service to our members.
Compensation And Benefits
We offer a robust benefits package for our full-time employees after a 90-day period, which includes:
- A 401(k) plan with company match available after one year of service.
- Competitive salary commensurate with experience,
- Comprehensive health, dental, and vision insurance,
- Generous vacation and paid time off policy,
- Flexible working hours.
Join our team and contribute to making a difference in the lives of our members! We look forward to welcoming you aboard.
Employment Type: Full-Time