Pharmacist I, Clinical Prior Authorization

CompanyNavitusAbout UsNavitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. 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.Pay RangeUSD $98,384.00 - USD $122,980.00 /Yr.Work Schedule Description (e.g. M-F 8am to 5pm)M-F 8am to 7pm CST per department need, on call and weekends as neededRemote Work NotificationATTENTION: We are unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.OverviewNavitus Health Solutions is seeking a Pharmacist I, Clinical Prior Authorization to join our Prior Authorization department! The Pharmacist I, Clinical Prior Authorization will be responsible for: performing Prior Authorizations; perform duties related to Drug Utilization Review including concurrent, retrospective, and prospective components; 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.Is this you? Find out more below! ResponsibilitiesHow do I make an impact on my team? 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; and to identify opportunities for improvement in efficiency, accuracy, and appropriateness of the programs in placeParticipate in the Coverage Determination (Certification, Prior Authorization, Medical Exception, Exception to Coverage, etc.) process be reviewing all requests which are not clearly approvable based on specified criteria (algorithms), making all coverage denial determinations, and identifying themselves by first name, title, and responsibility at Navitus in relation to drug utilization management program administrationContinually monitor the quality and efficiency of the Coverage Determination process including coverage criteria, denial language, and communication with prescribersProvide input to clinical content of new programs and for maintenance of existing programsComplete all annual URAC training requirementsFacilitation of communication and education to clients, members, and internal staff regarding clinical daily issues and objectivesProvide support to operational departments on the implementation of various PBM programs and daily functioning in support of member/patient quality of careResponsible for supporting / providing clinical expertise related to formulary decisions made by the Pharmacy and Therapeutics committeeMay review health care survey data for Medicare Part D qualified participants and/or perform phone consultations with Med-D enrollees; aid in documentation of calls; designate enrollees for repeat interactionOther duties as assignedQualificationsWhat our team expects from you? A minimum of a bachelor's degree in Pharmacy or Pharm D. Current unrestricted licensure as an RPh in the State of the home office of the pharmacist or the ability to gain reciprocity within 4 months of employment is requiredTwo years' work experience in a clinical setting, or clinical or managed care pharmacy practice residency preferredKnowledge of PBM industry, formulary management, pharmacy claims and managed care principles and practices desiredExceptional clinical skills and ability to apply sound clinical judgment to a variety of situations is necessaryProficiency in drug literature and clinical trial evaluation, including proficiency with electronic databases (e.g., Micromedex, Medline, Internet) preferredAbility to reason and translate clinical information into a manner appropriate for clinical systems and clinical/non-clinical audiencesEmphasis on problem-solving skills, including identifying and accepting a challenging situation and creating and implementing a solutionRequires attention to details to assure projects are clinically, editorially, and systems accurate and can be operationalizedProficiency in MS Word, Excel, Power Point including tables, charts and figures preferredParticipate in, adhere to, and support compliance program objectivesThe ability to consistently interact cooperatively and respectfully with other employeesWhat can you expect from Navitus? • Top of the industry benefits for Health, Dental, and Vision insurance • 20 days paid time off • 4 weeks paid parental leave • 9 paid holidays • 401K company match of up to 5% - No vesting requirement • Adoption Assistance Program • Flexible Spending Account #LI-Remote, We are unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.Location : AddressRemoteLocation : CountryUS Apply tot his job