Pharmacist

Are you an experienced Pharmacist looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions – this is the position for you!

Daily Responsibilities:  

• Provide timely drug therapy for Medicaid health plan members by processing prior authorization and medical necessity requests for specialty medications.

• Review specialty medication prior authorization requests (i.e. biopharmaceuticals) according to established treatment protocols, clinical criteria and member benefits. and make coverage determinations within the defined turnaround times and meet regulatory requirements

• Responsible for clinical criteria for specialty medications including analysis, monitoring of industry trends and develop criteria recommendations for Pharmacy and Therapeutics Committee and clients

• Define and coordinate prior authorization and drug utilization reviews reports for clients and ensure regulatory reporting requirements for drug utilization review and fraud and abuse reporting are met

• Develop and design specialty medication clinical edits for claims adjudication and enhanced drug utilization review

Hours for this Position:

• 40 hour workweek; 9:00am- 6pm or 10am-7pm

• Pay rate starts at $57 per hour

Advantages of this Opportunity: 

• Competitive salary, negotiable based on relevant experience

• Benefits offered, Medical, Dental, and Vision

• Fun and positive work environment