US Tech Solutions
Pharmacist – Clinical Operations Advisor - Medical Prior Authorization
US Tech Solutions, New York, New York, United States
Duration: 6+ months contract
Shift: 7am to 10pm CST - 8 hours/day
Job Description: 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. This role will work from supported systems and take inbound calls from physician or members regarding their pending, approved, or denied prior authorizations.
Responsibilities: Collaborates with the Technicians and Nurses to process authorization requests, 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. (20%) Coordinates timely communication of case decision to physician, health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes. (15%) Handles inbound phone calls and escalations from physicians or patients regarding Prior Authorization (50%) Establishes and maintains communication among, health plan and employer group staff. (5%) Maintain professional and technical knowledge of drug and disease-states for the Specialty Medical programs administered within the Novologix. (5%) Performs other related projects and duties as assigned including on call and after hours pharmacist availability could be required. (5%)
Experience: Position requires proficiency with computer skills which include multitasking, navigating multiple systems, and keyboarding. Experience using MS Office, other Windows based computer applications, web based processing and telephony programs. Minimum 2 years’ recent experience reviewing and processing prior authorizations against health plan criteria for a determination in a specialty/skilled clinical setting i.e., specialty medical office or Pharmacy Benefits Manager (PBM)
Skills: MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. MUST HAVE 6 months of experienced with Prior Authorization(required). MUST HAVE experience with Medicare Part D Must Have Pharmacy Benefit Management (PBM) experience.
Education: Pharm D. required with at least two years experience as a pharmacist in Managed care environment. Must have an active license in the state of residence in good standing.
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 www.ustechsolutions.com.
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Recruiter Details: Name: Sahil Email:
sahil.j@ustechsolutionsinc.com Internal Id:
25-47410
Shift: 7am to 10pm CST - 8 hours/day
Job Description: 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. This role will work from supported systems and take inbound calls from physician or members regarding their pending, approved, or denied prior authorizations.
Responsibilities: Collaborates with the Technicians and Nurses to process authorization requests, 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. (20%) Coordinates timely communication of case decision to physician, health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes. (15%) Handles inbound phone calls and escalations from physicians or patients regarding Prior Authorization (50%) Establishes and maintains communication among, health plan and employer group staff. (5%) Maintain professional and technical knowledge of drug and disease-states for the Specialty Medical programs administered within the Novologix. (5%) Performs other related projects and duties as assigned including on call and after hours pharmacist availability could be required. (5%)
Experience: Position requires proficiency with computer skills which include multitasking, navigating multiple systems, and keyboarding. Experience using MS Office, other Windows based computer applications, web based processing and telephony programs. Minimum 2 years’ recent experience reviewing and processing prior authorizations against health plan criteria for a determination in a specialty/skilled clinical setting i.e., specialty medical office or Pharmacy Benefits Manager (PBM)
Skills: MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. MUST HAVE 6 months of experienced with Prior Authorization(required). MUST HAVE experience with Medicare Part D Must Have Pharmacy Benefit Management (PBM) experience.
Education: Pharm D. required with at least two years experience as a pharmacist in Managed care environment. Must have an active license in the state of residence in good standing.
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 www.ustechsolutions.com.
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Recruiter Details: Name: Sahil Email:
sahil.j@ustechsolutionsinc.com Internal Id:
25-47410