Position Summary:
The clinical pharmacist is an operation based role that conducts clinical reviews of medical data collected to perform prior authorization for specialty medications. The clinical pharmacist will apply clinical knowledge to plan approved criteria for prospective and concurrent reviews of cases. authorizations.
Duties
1. Collaborates with the CRU Technician to process referrals, including answering clinical questions, collecting appropriate clinical/ medical data needed to perform clinical assessments, and reviews as per the healthplan/employer agreed criteria within the designated service level agreements. (20%)
2. Coordinates timely communication of case decision to physician, health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes. (15%)
3. Handles inbound phone calls and escalations from physicians or patients regarding Prior Authorization (50%)
4. Establishes and maintains communication, health plan and employer group staff. (5%)
5. Maintain professional and technical knowledge of drug and disease-states for the Specialty Pharmacy programs administered within the Case Review Unit. (5%)
6. Performs other related projects and duties as assigned including on call and after hours pharmacist availability could be required. (5%)
Experience
Preferred 0-3 years work experience required in a customer service position with high volume call center experience; preferably in healthcare, social services, or a similar service position
Education
•High School Diploma or GED required
•Bachelor's degree in related field or equivalent work experience preferred
Skills:
Healthcare, calling, prior authorization
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.