Looking for Pharmacist who have Remote Prior Authorization Experience & Must be licensed in the state of North Carolina. (Can reside in any state.)
This position is for a Clinical Pharmacist working in the Prior Authorization team.
This Pharmacist will:
- Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design. Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians, and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols. One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed‑upon approval & denial management processes.