- Telephonically provide clinical support to the PerformRx Contact Center.
- Engage providers in discussions to support determinations.
- Support Fraud and Abuse program system oversight.
- Participate in various Pharmacy-related projects.
- Keep abreast of industry trends and regulatory changes.
- Keep abreast of operational directives and customer reference materials.
- 2 years pharmacy experience preferred.
- Previous experience in managed care environment preferred.
- Current pharmacy license, Commonwealth of Pennsylvania preferred. Pharm D. preferred.
- CLINICAL SUPPORT
- PHARMACY
- MANAGED CARE
- PHARM D
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Pharmacist - Philadelphia, United States - Ohm Systems, Inc
Description
Duties:As a licensed health care professional employed in the Pharmacy Prior Authorization Department your primary responsibility is to make determinations on prior authorization and coverage requests for pharmaceutical products. Determinations include medical necessity and benefit decisions. Decisions are made in accordance with established pharmacy guidelines, contract criteria, industry regulations and sound clinical judgment. The Prior Authorization pharmacist works independently with respect to reviews and decision making, with the support of senior pharmacist staff and supervisors. You will work as member of a team of peers committed to meeting or exceeding quality standards and customer performance guarantees. Additional responsibilities include:
Skills:
Education:
Required Skills:
Ohm Systems, Inc. specializes in IT and Healthcare staffing services, dedicated to linking highly skilled professionals with our public and private clients across the United States. Our track record showcases our commitment to delivering outstanding staffing and consultancy solutions to our clients. We prioritize diversity and inclusivity and take pride in being an employer that promotes equal opportunities and affirmative action. Our goal is to foster an inclusive work environment that embraces individuals from all backgrounds, irrespective of their gender, race, or orientation.
