Job Description
Duration: + months contract
Job Description:
The clinical pharmacist is an operation based role that conducts clinical reviews of medical data collected to perform prior authorization for commercial and 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 Virtual systems and take inbound calls from physician or members regarding their pending, approved, or denied prior authorizations.
Responsibilities:
Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design. Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department proto...
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