Job Description

Job Title: Pharmacist

Duration: 03+ months

Location: Fully Remote

Shift: Day 5x8-Hour (08:00 - 05:00) EST

Role Overview

• The Pharmacist is responsible for dispensing prescription medications to patients and offering expertise in the safe use of prescriptions. This r
• ole includes conducting health and wellness screenings, providing immunizations, overseeing medications given to patients, and advising on healthy lifestyles. The position operates remotely and does not involve direct member-facing duties or work within a partnered clinical facility.

Responsibilities :

• Reviews a completed prior authorization request received from the provider and/or reviews the pharmacy technician's recommended denial, suggested formulary alternatives, comments and attachments for appropriateness.
• Verify member's ID number and date of birth.
• Verifies member's eligibility in the appropriate health plan eligibility system.
• Records carrier and group number if applicable.
• Checks for previous prior authorization decisions.
• Verifies coverage in member's prescription benefit when necessary.
• Verifies coverage in member's health plan benefit when necessary.
• Evaluates prescription claim history.
• Reviews chart notes and/or lab values.
• Identifies provider specialty when appropriate.
• Applies Medical Policy Criteria to prior authorization requests.
• Evaluates whether request meets criteria for approval.
• Reviews the request using professional clinical judgment on a case-by-case basis. A pharmacist will review medication requests not addressed by P&T Committee criteria or guidelines, develop and draft criteria for the non-formulary medication requested.
• Researches and contributes drug references and clinical information to facilitate prior authorization review: directly to physicians via fax or phone encounter; or to pharmacy technicians via memo or on a personal level as an educational tool.
• Communicates with physicians regarding prior authorization:
• For a non-formulary drug
• Plan benefits, exclusions.
• Quantity limits
• Age restrictions
• Formulary alternatives
• Retrieves and collects data through available reporting resources (i.e., Discoverer, IT Department)
• Compiles data for reporting purposes:
• Drug utilization of non-formulary drugs
• Overturned IPS recommended denials.
• Audit pharmacy claims greater than $200.00.
• Suggest addition or deletion of drugs to/from the formulary.
• Updating qty/days or age limit ends
• Support National P&T Committee
• Other tasks which may arise during the performance of any of the above-mentioned duties.
• Performance Expectations
• Case Signing: Sign 85-100 cases daily.
• First Day Experience
• Orientation: Orientation of department and systems.
• Required Skills and Experience
• Pharmacy Experience: Any setting (clinical/retail background helpful).
• Education: Doctor of Pharmacy (PharmD) or Bachelor of Science Pharmacy degree.
• Certifications: Current pharmacist license in good standing with the State Board of Pharmacy.
• Preferred Skills and Experience
• Software Skills: Proficiency with Office Suite.
• Additional Information
• Work Environment: Remote
• Internal/External Groups: No direct member-facing or partnered clinical facility work.

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