Adecco Medical and Science has an opening for a Licensed Pharmacist in San Diego, CA.
This position is for a Clinical Pharmacist working in a Pharmacy Call Center - Prior Authorizations Department. The pharmacist's primary role is reviewing Prior Authorization cases and rendering coverage determinations based on clinical criteria and plan design in a fast paced and dynamic environment.
Top Three Responsibilities
1. Pharmacy Call Center - receiving phone calls from prior authorization pharmacy technicians and/or providers for clinical information
2. Consult physicians/providers/ pharmacy technicians with questions, interpret clinical guideline criteria, and render/review coverage determination for prior authorization cases
3. Gather complex clinical information, coverage policy and criteria information and work within regulatory guidelines to make coverage determinations
Knowledge and Skills:
Fully understands pharmacy reimbursement issues (third party insurance, Medicare Part D, Medicaid, formulary management)
Understands the processes and procedures necessary to remedy on-line claim rejections
Up to date clinical skills - (through current work practice or demonstrated upon interview)
- Active, unrestricted California Pharmacist license
- Excellent written and verbal communication skills
- Computer and typing proficiency is required, including MS Office applications (Word, Excel, PowerPoint and Outlook)
- Experience in PBM, Commercial (private), and/or Medicare Part D prescription drug plans, programs or formularies
- Experience in Coverage Determinations (prior authorization) or member appeals
8 hour shift must be available between 6am to 10pm PST M-F, 6-3pm PSTT Saturday and Holidays. May change based on business needs. Dependent on business needs, there may be required Overtime and Holidays.
If you are interested in this opportunity or other opportunities available through https://www.adeccousa.com please apply online or for immediate consideration - email your resume directly to email@example.com.
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