Pharmacist

Amerihealth Caritas•Philadelphia, PA

3d•Remote

About The Position

The Pharmacist works in the Prior Authorization Department as a licensed healthcare professional. The primary responsibility is to make determinations on prior authorization requests for coverage of pharmaceutical products, including medical necessity and benefit decisions. Decisions are made according to established pharmacy guidelines, prior authorization criteria, industry regulations, and sound clinical judgment. The Pharmacist works independently on reviews and decision making, with support from Pharmacist II colleagues and supervisors, and as part of a peer team committed to meeting or exceeding quality standards and customer performance guarantees. The position is remote and scheduled Monday through Friday, 10:00 AM to 6:30 PM EST; the schedule may change to meet operational demands. A rotating weekend schedule may be required if business needs dictate. The pharmacist must hold an active pharmacist license in good standing in any U.S. state.

Requirements

Active pharmacist license in good standing in any U.S. state.
Bachelor's degree.
Proficient PC skills in a Windows-based environment.

Nice To Haves

PharmD preferred.
Prior Authorization or Coverage Determination experience preferred.

Responsibilities

Make determinations on prior authorization requests for coverage of pharmaceutical products, including medical necessity and benefit decisions.
Apply established pharmacy guidelines, prior authorization criteria, industry regulations, and sound clinical judgment when making decisions.
Provide clinical support to the Perform Rx Customer Care Center.
Engage providers in discussions to support determinations.
Support Fraud and Abuse program oversight.
Keep abreast of industry trends and regulatory changes.
Keep abreast of operational directives and customer reference materials.
Work independently on reviews and decision making while contributing to a peer team that meets or exceeds quality standards and customer performance guarantees.