Prior Authorization Pharmacist

DescriptionWHO WE AREFounded in 1983, the Medical Review Institute of America (MRIoA) is the market leader for technology-enabled utilization management and clinical medical review solutions. We have an outstanding reputation for excellence and achieve continual improvement.At MRIoA, we believe our employees are the key to our success. Here, you are more than just a cog in the machine – you are a valued member of our team.WE OFFERA competitive compensation package.Benefits include healthcare, vision and dental insurance, a generous 401k match, paid vacation, personal time, and holidays.Growth and training opportunities.A team atmosphere with fun events and prizes scheduled throughout the year.POSITION OVERVIEWThe PA Pharmacist is an important member of the pharmacy department. The PA Pharmacist works alongside the Supervisor, PA Pharmacists to set and meet production goals and to ensure each prior authorization is completed on time and in accordance with the individual client’s prior authorization criteria. The PA Pharmacists also serve as a drug information resource for MRIoA physicians and reviewers. Roles:To evaluate prior authorizations for drug appropriateness per drug policy criteriaTo provide cost-effective, rational drug therapy and disease state managementTo provide excellent customer service to health plan clients, practitioners, and membersTo serve as an educational resource regarding drug and clinical information for all internal and external customers Primary Responsibilities or Assigned Duties:Perform case reviews for prior authorizationsComplete Peer-to-Peer reviews with healthcare professionals regarding the outcomes of prior authorizationsServe as an active member of client committees, as requestedMonitor prescription turnaround time so that internal standards and client performance guarantees are metServe as a resource for team members for clinical and drug informationAssist in implementing programs and process improvements to enhance the level of internal and external customer service providedProvide a high-quality review of requested medication with clear notes of determinationCommunicate with team and Supervisor, PA Pharmacist as appropriate to proactively inform of issues or concernRecognize and recommend operational improvementsOther special projects and tasks as assignedRequirementsSkills and Experience:Possess a strong drug knowledge and able to clinically evaluate all drug authorization requests correctlyAbility to work in a fast-paced and high-functioning environment and meet deadlines while managing multiple high priorities Personal computer literacy and high competency in use of Microsoft Word and ExcelStrong organizational skills with attention to detailsStrong oral and written communication skillsWell-developed training skillsStrong working knowledge of medical insurance terminology and processesExcellent critical thinking capabilities with a strong attention to detailExceptional customer service skillsMinimum two years of experience as a pharmacist preferredPharmacy Benefit Management experience preferredCredentialed and privileged by the company's credentialing committeeWillingness to obtain additional state licensure as required for the positionEducation:PharmDPharmacist license in good standingWork Environment:Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required. This role is designed to be a remote position (work-from-home).Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment. Originally posted on Himalayas

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