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Job Description:This position is responsible for receiving verbal and written requests for prior authorization from pharmacists, physicians and/or patients and is responsible for supporting and assisting in the coordination of Pharmacy Services activities including claim utilization analysis, prescription plan design, ad-hoc reporting, correspondence and special projects. Must maintain performance in compliance with organizational or department goals and in compliance with regulatory agencies
Responsibilities:
Process prior authorizations received via prior authorization help line, by evaluating the medical necessity/appropriateness for specific drugs and based on medical criteria.
- Directly interact with members physician office staff, pharmacies and internal stake holders for eligibility, coverage determination claims issues.
- Conduct intervention with physician & pharmacy office staff to facilitate formulary compliance and generic dispensing.
- Process appeals complaints executive inquiries and compliance related issues.
- Provide recommendations to increase efficiency, accuracy and productivity in the department.
- Process ad hoc request for information or reports from stakeholders.
- Participate in client member and employee training to ensure practical understanding of pharmacy services programs and operations.
- Assist in the day to day business functions of the pharmacy department as well as the Medication Therapy Management program.
- Provide support to various clinical programs within the pharmacy department.
Education/Experience:
Bachelor's degree from an accredited college or university in Health Care Management, Business or Pharmaceutical Administration.
- Requires minimum of two (2) years experience in third party prescription program claim adjudication.
- Requires minimum of two (2) years experience as a Pharmacy Utilization Management Specialist.
- Requires prior customer service/service quality initiative experience.
Job Type: Contract
Pay: $15.00 - $18.00 per hour
Expected hours: 40 per week
Schedule:
Education:
Experience:
License/Certification:
Work Location: Remote
Contractor
$91k-106k (estimate)
09/02/2023
05/15/2024
The job skills required for Pharmacy Specialist include Health Care, Customer Service, Medication Therapy Management, Planning, Initiative, etc. Having related job skills and expertise will give you an advantage when applying to be a Pharmacy Specialist. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Pharmacy Specialist. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Pharmacy Specialist positions, which can be used as a reference in future career path planning. As a Pharmacy Specialist, it can be promoted into senior positions as a Pharmacist Manager that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Pharmacy Specialist. You can explore the career advancement for a Pharmacy Specialist below and select your interested title to get hiring information.