The Judge Group - New York, NY
posted about 2 months ago
Full-time - Entry Level
Remote - New York, NY
Administrative and Support Services
About the position
The Clinical Pharmacist position in the Prior Authorization unit is a remote role focused on reviewing prior authorization cases and making coverage determinations based on clinical criteria and plan design. This position operates within a call center environment, requiring adherence to strict work guidelines while providing excellent customer service and maintaining compliance with pharmacy laws and regulations.
Responsibilities
- Receive phone calls from prior authorization pharmacy technicians and/or providers for clinical information.
- Consult with physicians/providers to interpret clinical guideline criteria and render/review coverage determinations for prior authorization cases.
- Advise pharmacy technicians and/or physicians on medication use and appropriate formulary alternatives when requested.
- Gather complex clinical information and work within regulatory guidelines to make coverage determinations.
- Organize workload, set priorities, and complete assignments in a timely manner while complying with department standards.
- Perform all duties in compliance with state and federal pharmacy laws and regulations.
- Support department quality assurance and improvement guidelines.
- Build rapport with coworkers and internal customers, demonstrating a strong customer service orientation.
Requirements
- Active state Pharmacist license.
- Ability to work with PC, including using a mouse and keyboard, and navigating multiple systems and screens.
- Excellent attendance record.
Nice-to-haves
- Experience in a call center environment.
- Familiarity with prior authorization processes.
Benefits
- Scheduled overtime opportunities.
- Potential for working on holidays.
