Pride Health is hiring for a Prior Authorization Pharmacist in MST/PST timezones! (Remote)
Schedule: 5 days per week (must have weekend availability), must have availability as early as 5am and as late as midnight, includes scheduled overtime and working on holidays
Pay Rate: $54-62/hour
Type: Contract to permanent
Primary Responsibilities:
- Decisioning and processing member prescriptions or prior authorizations through various computer systems ensuring the accuracy of all data and updating as necessary
- Work is computer based and include receiving phone calls from prior authorization pharmacy technicians and/or providers for clinical information
- Consult physicians/providers with questions, interpret clinical guideline criteria, and render/review coverage determination for prior authorization cases
- Consult with pharmacy technicians and/or physicians regarding use of medications and advise of appropriate formulary alternatives when requested.
- Gather complex clinical information, coverage policy and criteria information and work within regulatory guidelines to make coverage determinations
- Organize workload, sets priorities, completes assignments in a timely manner and utilizes resources appropriately while complying with department program standards
- Perform all duties and functions in compliance with state and federal pharmacy laws and regulations
- Conform with and supports department quality assurance and improvement guidelines
- Dedication to build rapport with coworkers, internal customers, and other departments by demonstrating a strong customer service orientation and a continuous positive image
- Demonstrate ability to maintain productive working relationships with team members, other internal and external customers, and management team.
- Safety is paramount and it s important for employees to have a safe and secure workspace and communicate with their leadership when that safety (equipment, system, information) is compromised.
Required Qualifications:
- Pharmacist license in good standing in current state
- Prior Authorization experience
Apply with Pride Health for this opportunity!
Pride Global offers eligible employee s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.