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Pharmacist I - Prior Authorization
Ref No.: 18-23945
Location: Philadelphia, Pennsylvania
Job Title: Pharmacist I - Prior Authorization
Duration: Long Term Assignment
Location: Philadelphia, PA
As a licensed health care professional employed in the Pharmacy Prior Authorization Department primary responsibility is to make determinations on prior authorization and coverage requests for pharmaceutical products. Determinations include medical necessity and benefit decisions. Decisions are made in accordance with established pharmacy guidelines, contract criteria, industry regulations and sound clinical judgment.  The Prior Authorization pharmacist works independently with respect to reviews and decision making, with the support of senior pharmacist staff and supervisors. Will work as member of a team of peers committed to meeting or exceeding quality standards and customer performance guarantees. Additional responsibilities include:
Telephonically provide clinical support to the Contact Center
Engage providers in discussions to support determinations
Support Fraud and Abuse program system oversight.
Participate in various Pharmacy-related projects
Keep abreast of industry trends and regulatory changes
Keep abreast of operational directives and customer reference materials
2 years pharmacy experience preferred. •Previous experience in managed care environment preferred
Current Pharmacist license, Commonwealth of Pennsylvania preferred. Pharm D. preferred.