Remote Clinical Prior Authorization Pharmacist

Navitus Health Solutions, LLC • Remote (Baton Rouge, Louisiana, United States) • $0 / year • 7h ago

Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. STAR Bonus % (At Risk Maximum) M-F 8am-5pm holidays, weekends, on-call

Remote Work Notification Navitus is only able to offer remote work to residents of Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Washington DC, Wisconsin.

The Pharmacist I, Clinical Prior Authorization will be responsible for: performing Prior Authorizations; and support Customer Care with clinical calls requiring pharmacist intervention. The Pharmacist I, Clinical Prior Authorization is also responsible for interfacing with physicians, pharmacists, and specialty pharmacy providers with respect to beneficiaries’ benefits and therapeutic interventions, and reviewing/evaluating the health surveys and utilization data for program management and development. Responsible for support and input to clinical programs such as: Health Management, Drug Utilization Review, Formulary development, and Prior Authorization programs to encourage appropriate, high quality, cost effective drug therapy; Participate in the Coverage Determination (Certification, Prior Authorization, Medical Exception, Exception to Coverage, etc.) Continually monitor the quality and efficiency of the Coverage Determination process including coverage criteria, denial language, and communication with prescribers Provide input to clinical content of new programs and for maintenance of existing programs Complete all annual URAC training requirements Provide support to operational departments on the implementation of various PBM programs and daily functioning in support of member/patient quality of care Responsible for supporting / providing clinical expertise related to formulary decisions made by the Pharmacy and Therapeutics committee May review health care survey data for Medicare Part D qualified participants and/or perform phone consultations with Med-D enrollees; A minimum of a bachelor’s degree in Pharmacy or Pharm D. Other State Pharmacy Licenses may be required as business need dictates. Two years’ work experience in a clinical setting, or clinical or managed care pharmacy practice residency preferred Knowledge of PBM industry, formulary management, pharmacy claims and managed care principles and practices desired Proficiency in drug literature and clinical trial evaluation, including proficiency with electronic databases (e.g., Requires attention to details to assure projects are clinically, editorially, and systems accurate and can be operationalized Proficiency in MS Word, Excel, Power Point including tables, charts and figures preferred Top of the industry benefits for Health, Dental, and Vision insurance ~9 paid holidays ~Adoption Assistance Program ~ Flexible Spending Account ~ Educational Assistance Plan and Professional Membership assistance ~ Referral Bonus Program – up to $750!

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