Job Description
Job Title: Pharmacist I
Location: New York, NY
Duration: 03 Months
Schedule: Monday-Friday 9 am to 5:00 pm
Oncology & Compounding experience preferred .
Pay Range: $85/HR TO 90/HR ON W2
**AUTO/QUICK OFFER - URGENT HIRING**
**STIPEND IS ALSO PROVIDED TO THE CANDIDATE LIVING MORE THAN 50 MILES FROM THE FACILITY**
Responsibilities:
- Review’s physician inquiries for pharmacy, physician-administered, or home infusion pre-authorization and medical necessity requests based on established pharmacy guidelines and contract criteria.
- Forwards initial denials to appropriate queue for further review.
- Generates notification letters to members and physicians on approved and denied requests.
- Handles calls and correspondence from providers; responds to inquiries, complaints and reconsiderations.
- Documents calls in inquiry tracking system.
- Using established protocols ensures resolutions provided are presented in a clear and accurate manner.
- Receives escalated calls that cannot be clinically resolved by 1st level intervention.
- Research, resolves and responds to provider clinical inquiries.
- Supports Fraud and Abuse program system oversight.
- Communicates any suspected fraud discovered by the contact center staff.
- Recommends course of action for providers where patterns appear outside of guidelines and generally accepted pharmacy standards.
- Serves as second line contact for all internal pharmacy related issues.
- Functions as clinical liaison between internal staff and pharmacy network participants.
- Ensures internal changes that may affect network services are reflected in the claims processing system.
- Conducts research necessary to maintain Prior Authorization Criteria, including therapeutic category and comparative drug review.
- Works with appropriate individuals/vendors to facilitate compliance.
- Responds to and drafts correspondence to physicians regarding requests on Drug Formulary.
- Responds to telephone inquiries from physicians, other healthcare professionals and members regarding select drug information.
- Keeps abreast of industry trends and regulatory changes in the pharmacy industry and evaluates their effect on pharmacy contracts and services.
- Makes recommendations on program improvements, based on findings and utilization.
Careers Integrated Resources Inc
Job Tags
Contract work, Immediate start, Monday to Friday,