Pharmacist I - Raleigh, United States - Ohm Systems

Description

Job 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:

• 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

Skills:

• 2 years pharmacy experience preferred
• Previous experience in managed care environment preferred

Education

• Current pharmacy license, Commonwealth of Pennsylvania preferred. Pharm D. preferred.

Required Skills

• CLINICAL SUPPORT
• PHARMACY
• MANAGED CARE
• PHARM D