Managed Care Clinical Pharmacist - Remote

Tenet Healthcare Corporation-posted 19 days ago

$45 - $67/Yr

Full-time • Mid Level

Remote • Frisco, TX

5,001-10,000 employees

Hospitals

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We are seeking a dedicated and detail-oriented clinical pharmacist for an operation-centric role focused on conducting clinical reviews of medical data to facilitate prior authorization for specialty medications. Provides clinical pharmacy services and support to assist the Prior Authorization, Case Management and Quality teams.

Prior Authorization review and approve or deny coverage for pharmaceuticals based on medical necessity criteria. Coordinates with medical directors as needed
Specialty Drug claims review based on medical necessity criteria
Comprehensive Medication Management Review for complex members in Case Management
Assists withTransitions of Care Medication Reconciliation Post-Discharge (TOC MRP)
Supports Quality with Medication Adherence Measures
Redirects pharmaceuticals to PBM when appropriate

Ability to communicate effectively both verbally and in writing.
Experienced computer skills with Microsoft Word, Microsoft Outlook, Excel and experience working in a health plan medical management documentation system.
Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.
Requires BA/BS in Pharmacy; PharmD preferred
Three (3) to Five (5) years of pharmacy experience.
Requires a registered pharmacist
Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh)
Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills a must
Must be able to work in sitting position, use computer and answer telephone
Ability to travel
Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments
Office Work Environment

Experience reviewing Medical Drugs (J-codes and Q-codes a plus
Two years of managed care experience in Medical Management preferred.
ICD-9 and CPT coding experience preferred.
Experience in EZ-CAP preferred.
Prefer Prior Authorization experience

Medical, dental, vision, disability, and life insurance
Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.
401k with up to 6% employer match
10 paid holidays per year
Health savings accounts, healthcare & dependent flexible spending accounts
Employee Assistance program, Employee discount program
Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act.

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Managed Care Clinical Pharmacist - Remote

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