Adecco Medical and Science has an upcoming opening for a Licensed Pharmacist in Costa Mesa, CA
Must have Prior authorization, appeals, or health plan experience highly preferred. Will consider retail candidates with strong clinical skills and experience. Strong written and verbal communications skills required. Ideal candidate has worked for a large PBM - pharmacy insurance company
Top 3 responsibilities:
1. Review Medicare Part D prescription drug claims that have been denied under plan benefit guidelines; apply Medicare Part D Plan formulary guidelines and utilization management guidelines to determine if the drug should be a covered benefit for the beneficiary based on their medical history.
2. Decisions to overturn the denial of the prescription drug claim may require consulting with Plan Medical Directors and the beneficiaries treating physician.
3. Answer questions from support personnel regarding prescription drugs.
Pharmacist license in good standing.
Must be experienced with Medicare Part D prescription drug formularies.
Must fully understand pharmacy reimbursement issues (third party insurance, Medicare Part D formulary management, Medicaid).
Understands the processes and procedures necessary to remedy on-line claim rejections.
Up to date clinical skills, technology based knowledge of MS Windows operating Word and Excel; experienced using email systems - MS Outlook preferred.
Experience using a web browser (internet Explorer application).
Experienced using online clinical references and accessing professional (clinical and regulatory) internet sites preferred by not required.
Experienced working with onscreen document images plus a language fluent English speaking and writing skills.
Able to communicate effectively and professionally in writing
This will be a Contract opportunity with possibilty of going permanent.
If you are interested in this opportunity or other opportunities available through https://www.adeccousa.com please apply online or email your resume directly to firstname.lastname@example.org.
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