Prior Authorization Pharmacist

• Serve as a clinical resource to the PA staff in reviewing denied, unclear or questionable PA requests. Communicate PA/appeal requirements to healthcare providers as requested.

•  Assist the PA managers and supervisors in the daily operations of the PA department including the planning and implementation of new client PA programs. Educate PA staff on client or company specific PA guidelines and processes.

•  Assist in administering PA appeal services including first level appeal reviews and coordination of 2nd level appeals with the appeal vendor.

•  Handle any escalated calls and other issues that may arise in the clinical call center to help maintain a smooth workflow and ensure turnaround times/SLAs are met for each client.

•  Assist in training activities for internal/external candidates entering the clinical call center

•  Other activities as determined by the PA Manager