*pharmacist - appeals - clinical - remote - united states, woonsocket
adecco is currently assisting a national pharmaceutical client, recruiting for a pharmacist). this role is 100% remote. the schedule is as follows: sun-sat 7a-12a (8hrs shifts, 5days/wk). training hrs mon-fri (2-4weeks). apply now!
pharmacist duties are:
the clinical appeals pharmacist is an operation based role that conducts clinical reviews of medical data collected to perform prior authorization/appeals for specialty medications. the clinical pharmacist will apply clinical knowledge to plan approved criteria for prospective and concurrent reviews of cases. this role will work from cvs caremark supported systems and take inbound calls from physician or members regarding their pending, approved, or denied prior authorizations/appeals. this position is for an experienced clinical pharmacist interested in appeals level reviews.
collaborates with the cru technician/lpn to process referrals, including answering clinical questions, collecting appropriate clinical/ medical data needed to perform clinical assessments, and reviews as per the health-plan/employer agreed criteria within the designated service level agreements. (20%)
coordinates timely communication of case decision to physician, health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes. (15%)
handles inbound phone calls and escalations from physicians or patients regarding prior authorization/appeals (50%)
establishes and maintains communication among cvs caremark, health-plan and employer group staff. (5%)
maintain professional and technical knowledge of drug and disease-states for the specialty pharmacy programs administered within the case review unit. (5%)
performs other related projects and duties as assigned including on call and after hours pharmacist availability could be required. (5%).
candidates must meet the following requirements to be considered:
licensed registered pharmacist.
minimum 3-5 years' experience although 5-8 years is preferred.
2 years prior authorization review and decisioning experience.
2 years background in hospital and retail environment.
knowledge of access, power point, and visio is preferable.
must be computer literate – knowledge of excel and word.
work from home requirements:
must understand you cannot be the primary caregiver to anyone in their home during scheduled work hours
you are required to provide their own high speed internet.
minimal home broadband connectivity speed of 25 mb download and 3 mb upload speed. speed for home internet can be confirmed by going to www.speedtest.net.
smartphones are required. the vpn token will need to be downloaded to the user’s smartphone.
that the assignment could be changed to an in office assignment.
click on apply now for instant consideration!
equal opportunity employer/veterans/disabled
the company will consider qualified applicants with arrest and conviction records
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