Pharmacy Program Coordinator - Clinical Prior Authorization

Cedars-Sinai Medical Center•Los Angeles, CA

1d•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

Pharm.D. or equivalent degree from an accredited school of pharmacy.
Current pharmacist licensure in the State of California.
BLS certification as outlined in the Pharmacist Responsibilities in Cardiopulmonary Resuscitation(C.P.R.).
Completion of a PGY1 residency or equivalent practice experience.
Excellent clinical data base.
Experience in Medication Use Evaluation.
Excellent verbal and written communication skills.
Software skills e.g., Microsoft Office.
Comprehensive knowledge of medical terminology as related to drug usage.
Comprehensive knowledge of common disease states and pathologies.
Ability to comprehend patient medical management plans.
Ability to assess and apply current pharmacological and biopharmaceutical principles for the selection and use of drug products in a clinical setting.
Ability to extract pertinent information from the patient or other sources and relate it to the patient care plan.
Possess the verbal and written communication skills required to fulfill the pharmacist’s responsibilities.
Ability to teach and serve as preceptor for training programs.
Knowledge of laws, regulations and standards relative to pharmacy practice.
Ability to adapt to change.
Ability to prioritize workflow.
Ability to learn and adapt to the use of automated information systems in daily practice.
Demonstrated competency in techniques of pharmaceutical calculations, compounding and pharmacokinetics.
Possess patient-centered communication skills.
Possess computer skills necessary to perform job functions.

Nice To Haves

Prior authorization experience is highly preferred.

Responsibilities

Ensure safe, effective, and reasonable use of high cost-drug therapies.
Support timely patient treatment and optimize reimbursement for high cost medications.
Support clinical prior authorizations for medical benefits.
Prevent denials and advocate for patients.
Assist in evaluation of payer (insurance) drug criteria.
Conduct payor update reviews.
Perform claim data analysis.
Assist with the appeal process.
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.
Prepare drugs needed for immediate administration.
Provide recommendations and monitor the use of drugs.
Evaluate medication regimens to meet the therapeutic needs of patients.