Candidates will be reviewing Medicare Part D members' prior authorization requests. Client-specific criteria are referenced to determine if a prior authorization can be approved or denied. The work is detail-oriented and candidates will be expected to provide clinical judgement and communication.
The Clinical Staff Pharmacist is responsible for the processing and documenting of Utilization Management requests (i.e. formulary exceptions, prior authorization, step therapy, quantity limit exceptions) for delegated products and services.
* Responsible for the clinical evaluation for coverage determination requests for prior authorization (PA) or other utilization management (UM) programs, including quantity limits, step therapy, formulary exception and tier exception, and includes consideration of the denial language and appropriateness of the decision as it pertains to the clinical content of the case and the intent of the individual client's pre-approved criteria
* Accountable for direct consultation with health care providers concerning non-formulary and clinical product coverage issues
* Collaborate with team members to promote consistency of decisions across the pharmacist team
* Other duties as assigned
We know that a company's success starts with its employees. We also know that an individual's success starts with the right career opportunity. As a Best of Staffing® Client and Talent leader, Aerotek's people-focused approach yields competitive advantage for our clients and rewarding careers for our contract employees. Since 1983, Aerotek has grown to become a leader in recruiting and staffing services. With more than 250 non-franchised offices, Aerotek's 8,000 internal employees serve more than 300,000 contract employees and 18,000 clients every year. Aerotek is an Allegis Group company, the global leader in talent solutions. Learn more at Aerotek.com.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please call 888-237-6835 or email firstname.lastname@example.org for other accommodation options. However, if you have questions about this position, please contact the Recruiter located at the bottom of the job posting. The Recruiter is the sole point of contact for questions about this position.