Pharmacist

CareSource•Indianapolis, IN

5d•Remote

About The Position

Pharmacist I is responsible for supporting the department, operational strategies, goals and vision. Pharmacists shall utilize pharmaceutical and clinical expertise to review Prior Authorizations requests within a timely manner, to promptly serve our CareSource members.

Requirements

Bachelor’s Degree in Pharmacy is required; Doctor of Pharmacy (PharmD) is preferred
Minimum of three (3) years of retail pharmacy experience is preferred
Minimum of one (1) year managed care or Medicare experience is preferred
Working knowledge of Microsoft Outlook, Teams, Word, Excel, and PowerPoint
Familiarity with the healthcare field, including Insurer, PBM, Specialty or Retail Pharmacy and Provider
Understanding Managed Care and/or Retail Pharmacy operations with respect to Medicaid, Marketplace and /or Medicare
Proficient in medical terminology, medication names, generics and biosimilars
Application of Clinical guidelines, policies, and decision trees/tools
Understanding the pharmacist’s clinical role in the care of members; utilization of Clinical expertise
Strong written and verbal Communication skills, including use of proper grammar in print and e-mail communications
Ability to simplify clinical language for lay persons
Critical listening, thinking and problem-solving skills
Attention to detail
Organized and learns quickly
Comfortable working in a fast-paced environment
Time management skills
Use of proper phone etiquette
Ability to work independently and within a team environment
Current, unrestricted Registered Pharmacist (RPh) licensure is required
Ability to acquire additional State License(s) in multiple states, as required

Responsibilities

Supports and participates in Prior Authorization (PA) Reviews by documenting, implementing and utilizing the following: Formulary Management guidelines, Utilization Management programs, CareSource Administrative and Operational policies and procedures, and/or other clinical programs
Execute critical thinking and decision processes when evaluating PA Reviews for Pharmacy and Medical Benefit medications
Conduct PA Reviews for Multi-State Medicaid and Marketplace lines of business
Provide written communications to members and providers upon decisioning of PA requests
Engage Providers in “Peer to Peer” discussions, and Clinical Consults, as requested
Assist Pharmacy PA call center staff
Provide support and collaborate with pharmacy technicians to ensure operational efficiencies
Adhere to Turn Around Time (TAT) requirements, per Line of Business
Observe Operational Productivity Goals and Metrics
Maintain exceptional quality
Cross-collaborate with Departmental and Organizational Teams
Perform any other job duties as requested