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Pharmacist - RPh Operations Advisor - Specialty Medical Prior Authorization Aetna

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Job ID: 25-286315

Position Type: Full time
 
Location: Remote

Work Type: Remote
 
Est. Pay Range: $53.00/hr. To $58.00/hr.

Position Summary:

  • The clinical pharmacist is an operation-based role that conducts clinical reviews of medical data collected to perform prior authorization for 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 supported systems and take inbound calls from physicians or members regarding their pending, approved, or denied prior authorizations.
 
Duties:
  • Collaborating with Technicians and Nurses to process authorization requests, including answering clinical questions, collecting appropriate clinical/medical data needed to perform clinical assessments, and reviews as per the health plan/employer agreed criteria within the designated service level agreements. (20%)
  • Coordinating timely communication of case decision to physician, health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes. (15%)
  • Handling inbound phone calls and escalations from physicians or patients regarding Prior Authorization (50%)
  • Establishing and maintaining communication, health plan and employer group staff. (5%)
  • Maintaining professional and technical knowledge of drug and disease-states for the Specialty Medical programs administered within the Novologix platform. (5%)
  • Performing other related projects and duties as assigned. On call and after hours pharmacist availability may be required. (5%)
 
Required Qualifications:
  • 2+ years of clinical experience with specialty medications orclinical review of prior authorization requests.
  • Experience using MS Office and other Windows based computer applications, strong organizational skills, interpersonal skills, and detail orientation are important for this position.
  • Required certification: Active pharmacist license in state of residence in good standing
 
Education:
  • Bachelor's degree in pharmacy or Pharm D. Required with at least two years experience as a pharmacist.
  • Must have an active license in good standing.

Employee Benefits:
At LanceSoft, full time regular employees who work a minimum of 30 hours a week or more are entitled to the following benefits:
Four options of medical Insurance
Dental and Vision Insurance
401k Contributions
Critical Illness Insurance
Voluntary Permanent Life Insurance
Accident Insurance
Other Employee Perks
 
LanceSoft is a certified Minority Business Enterprise (MBE) and an equal opportunity employer. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. LanceSoft makes hiring decisions based solely on qualifications, merit, and business needs at the time.
Remote

About the Company:
Lancesoft



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