Clinical Pharmacist Advisor Medicare - Providence, United States - Impresiv Health

Description

Title: Clinical Pharmacist Advisor Medicare

Schedule: Monday through Friday 7am - 8pm EST, Sat-Sun 7am - 4pm rotating shifts

Description:
As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. You will be responsible for ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to providers for more information when needed, and ensuring accurate decisions that comply with compendia and Medicare guidance and timelines. This is a great opportunity to initiate a career with a leading healthcare company by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience.
What You Will Do:

• Collaborates with multiple groups within CD&A, including answering clinical questions, collecting appropriate clinical/ medical data needed to perform clinical assessments, and reviews as per the health plan/employer agreed criteria within the designated service level agreements.
• Coordinates timely communication of case decision to physician, health-plan/employer, patient, and other healthcare professionals following agreed upon approval & denial management processes.
• Reviews cases in progress and provides a Clinical decision regarding Prior Authorizations, Tier Exceptions and Non-Formulary requests.
• Performs other related projects and duties as assigned including on call and after-hours pharmacist availability could be required.

You Will Be Successful If:

• Knowledge of Access, Power Point, and Visio
• Must be computer literate - knowledge of Excel and Word.
• Strong organizational skills, interpersonal skills and detail orientation important for this position.
• Minimum of one year's pharmacy experience in a retail or hospital setting preferred
• Experience in home infusion therapy is preferred.
• Previous pharmacy experience in retail or hospital preferred.
• Extensive Medicare Experience.

What You Will Bring:

• High School Diploma or GED required.
• Bachelor's degree in pharmacy or Pharm D required.
• Minimum 2+ years' experience as a pharmacist.
• Must have an active pharmacist license within state residence.

About Impresiv Health:

Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.

Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do - provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.

That's Impresiv