Prior Authorization Pharmacist

Pharmacist will be responsible for supporting the Prior Authorization program as well as other clinical services through the Clinical Call Center. This role will provide daily operational support to the PA department and Clinical Call Center and will serve as clinical resources for both internal and external Catamaran/United customers in regards to the PA program and other clinical call center activities.

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 Catamaran 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