Prior Authorization Pharmacist - REMOTE

Southern Scripts•Atlanta, GA

2d•Remote

About The Position

The Prior Authorization Pharmacist is responsible for the day-to-day operation of the PA team. The PA Pharmacist will ensure that all authorizations to the team are accurately obtained and reviewed in a timely manner. The PA Pharmacist will report directly to the Prior Authorization Manager.

Requirements

Pharmacist license in good standing.
Maintains continuation education requirements.
BS Pharm OR PharmD required.
Managed Care experience required.
Prior authorization review experience required.

Nice To Haves

Past use of PAHub preferred.

Responsibilities

Manages the assigned daily work queues within prior authorization system PAHub.
Ability to navigate other systems to assist with prior authorization review (drug information resources, clinical guidelines, claim system, benefit design system).
Assists manager with overseeing prior authorization technicians.
May review and approve or deny coverage for pharmaceuticals based on guideline-based prior authorization criteria, and coordinates with the Clinical team, Account Management and others as needed.
Serves as a clinical resource to other pharmacists.
May be responsible for assisting manager with development or updating of prior authorization criteria.
Involved with the review of prior authorizations to support the overall management of client member medication access.
Communicates process improvements as appropriate/approved to the team leader.
Assumes ownership of assigned tasks, prioritizes work with/without leader input and moves projects to completion (in a timely manner).
Participates in projects and/or meetings as assigned by manager.
Attends additional training, performs research, e-learning to stay current on best practices and new practice management technology and functionality as it becomes available.
Abide by all obligations under HIPAA related to Protected Health Information (PHI).
If a HIPAA violation is discovered, whether individually or by another, you must report the violation to the Compliance Officer and/or Human Resources.
Attend, complete, and demonstrate competency in all required HIPAA Training offered by the company.
Flexibility to understand, appreciate and embrace that this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.