Pharmacy Program Coordinator - Clinical Prior Authorization - Remote
About The Position
The remote Clinical Prior Authorization Pharmacist Specialist at Cedars-Sinai Medical Center will work in collaboration with the Prior Authorization Pharmacy Technician, Drug Use Policy, as well as the authorizing providers to ensure safe, effective, and reasonable use of high cost-drug therapies. Clinical Prior Authorization Pharmacists support timely patient treatment and optimize reimbursement for these medications. The prior authorization staff support clinical prior authorizations for medical benefits, prevent denials, advocate for patients and assist in evaluation of payer (insurance) drug criteria. Additional responsibilities include but are not limited to payor update reviews, claim data analysis, assist with appeal process, review and incorporate payor clinical criteria into medication use guideline. The Prior Authorization Pharmacist also provides supports in navigating and obtaining payer coverage approval to facilitate discharge and/or prevent an admission. The Pharmacist is responsible for clinical pharmacy services, including but not limited to identification of drug-related problems, identification of medication safety issues, review of medication orders for appropriateness and provision of in-services/drug information to the outpatient clinic sites of care and patients. The Clinical Prior Authorization Pharmacist Specialist will also supervise the associated pharmacy technicians.
Requirements
- Must be a licensed Pharmacist.
- Experience with clinical prior authorization.
- Familiarity with drug use policies.
- Ability to collaborate with authorizing providers.
- Understanding of payer (insurance) drug criteria.
- Experience with appeal processes.
- Ability to review and incorporate clinical criteria into guidelines.
- Experience in navigating payer coverage approval.
- Knowledge of drug-related problems and medication safety issues.
- Ability to review medication orders for appropriateness.
- Experience providing in-services/drug information.
- Supervisory experience.
Responsibilities
- Ensure safe, effective, and reasonable use of high cost-drug therapies.
- Support timely patient treatment and optimize reimbursement for high cost-drug therapies.
- Support clinical prior authorizations for medical benefits.
- Prevent denials for prior authorizations.
- Advocate for patients.
- Assist in the evaluation of payer (insurance) drug criteria.
- Conduct payor update reviews.
- Perform claim data analysis.
- Assist with the appeal process for prior authorizations.
- Review and incorporate payor clinical criteria into medication use guidelines.
- Provide support in navigating and obtaining payer coverage approval to facilitate discharge and/or prevent an admission.
- Provide clinical pharmacy services, including identification of drug-related problems and medication safety issues.
- Review medication orders for appropriateness.
- Provide in-services/drug information to outpatient clinic sites of care and patients.
- Supervise associated pharmacy technicians.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Number of Employees
5,001-10,000 employees
