Overview Clinical Staff Pharmacist Remote – 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. Responsibilities 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; evaluate denial language and the clinical content of the case to align with the client’s pre-approved criteria. 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. Minimum Qualifications Doctor of Pharmacy (PharmD) or Bachelor of Science Pharmacy Degree. Current pharmacist license in good standing with the State Board of Pharmacy. 1 year of relevant work experience. Must be eligible to work in the United States without the need for work visa or residency sponsorship. Additional Qualifications Excellent verbal and written communication skills. Ability to work independently and as part of a team. Preferred Qualifications Managed care experience. Proficiency with Microsoft Office. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures. Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. Prime retains the right to change or assign other duties to this job. Potential pay for this position ranges from $51.92 - $88.46 based on experience and skills. For benefits details, visit the Benefits Page and click on the "Benefits at a glance" button for more detail. Equal Opportunity Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law. We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law. Prime Therapeutics LLC is a Tobacco-Free Workplace employer. #J-18808-Ljbffr Prime Therapeutics
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