- US Tech Solutions (May, OK)
- …as a Prior Authorization Pharmacist is required. **Skills:** + Prior authorization + PBM **Education:** + Bachelor's degree in pharmacy or Pharm ... role that conducts clinical reviews of medical data collected to perform prior authorization for specialty medications. The clinical pharmacist will apply… more
- US Tech Solutions (May, OK)
- …on prior authorizations, candidates with that experience are preferred. **Skills:** + Prior authorization + PBM **Education:** + Bachelor's degree in ... + This position is responsible for reviewing and completing criteria based on prior authorization as per policy and procedure. **Responsibilities:** + Reviewing… more
- US Tech Solutions (May, OK)
- **Job Description:** + Responsible for reviewing and completing criteria based on prior authorization as per policy and procedure. **Responsibilities:** + This ... be responsible for: Reviewing and completing criteria based on prior authorization as per policy and procedure....Medicare Part D + Must Have Pharmacy Benefit Management ( PBM ) experience. **Education:** + Pharm D. required with at… more
- US Tech Solutions (RI)
- **Job Title: Prior Authorization Specialist** **Location: Fully remote** **Duration: 12 months contract** **Job Description:** + Prior Authorization ... phone assistance to all callers through the criteria based prior authorization process. + Maintains complete, timely...all clinical questions, escalations and judgement calls to the pharmacist team. + The Rep I, Clinical Services will… more
- CVS Health (Pittsburgh, PA)
- …disease management and therapeutics. Knowledge of utilization management interventions including prior authorization , step therapy, quantity limits and formulary ... to join our growing team as a Clinical Development Pharmacist ! Are you looking for a clinically interesting role...in good standing - 2+ years of managed care experience/ Prior Authorization experience - 1+ years experience… more
- US Tech Solutions (May, OK)
- …and courteous phone assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and accurate documentation of ... all clinical questions, escalations and judgement calls to the pharmacist team. The Rep I, Clinical Services will also...the leadership team. Work closely with providers to process prior authorization (PA) and drug benefit exception… more
- US Tech Solutions (May, OK)
- …on prior authorization as per policy and procedure. **Experience:** ** Prior authorization experience is required.** ** PBM Experience is required.** ... skills, and detail orientation are important for this position. **Skills:** ** Prior Authorization ** **Pharmacy Benefit Management** **Medicare Part D**… more
- VNS Health (Manhattan, NY)
- …and clinical operations. + Participates in the decision making process for Prior Authorization and grievances and appeals processes related to pharmacy ... across all business lines. Resolves problems regarding Pharmacy Benefit Manager ( PBM ) clinical pharmaceutical services. Serves as a clinical pharmacy resource for… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- … with its rebate operations. Directs the non-clinical functions delegated to the Prior Authorization and State Supplemental Rebate Unit of the statewide Medicaid ... meeting dates, disseminate clinical packets to P&T committee members prior to each meeting, and organize day-of meeting activities....the PBM Unit and supervision of other PBM Program functions as delegated by the Pharmacist… more
- Sharp HealthCare (San Diego, CA)
- …Plan.Monitors the PBM adjudication system and identifies discrepancies.Communicates prior authorization decision to medical offices and/or pharmacies, within ... Do** To assist in the day-to-day operations of the pharmacist and pharmacy department and maintain quality of service... PBM vendor.Performs training for new employees. + Prior authorization requestsReceives and processes prior… more
- Sharp HealthCare (San Diego, CA)
- …the PBM adjudication system and identifies discrepancies.Communicates prior authorization decision to medical offices/pharmacies, within established ... to obtain laboratory data or pertinent chart notes for all prior authorization requests.Processes information received, verifying eligibility and benefits… more
- Centene Corporation (Phoenix, AZ)
- …defined criteria + Enters and documents coverage determination and/or prior authorization request decisions into the PBM system and notify providers and/or ... D Operations and State Health Programs Pharmacy Operations or Prior Authorization . Using established company guidelines, the...members + Responds to client inquiries regarding authorization approvals and PBM online applications +… more
- InnovaCare (San Juan, PR)
- …CMS requirements to the members and prescribing physicians. Perform system overrides (eg, prior authorization ) on the PBM claims processing system to ... other job related duties as assigned by the Supervisor. General knowledge of Prior authorization criteria and pharmacy claims processing. Provide support to… more
- Actalent (Mcallen, TX)
- …terminology, health care, medicare, Pharmacy, Cpht, Pharmacy technician certification, Prior authorization , Retail pharmacy, insurance, data entry, support, ... technician certificate Top Skills Details: medical,medical terminology,health care,medicare,Pharmacy,Cpht,Pharmacy technician certification, Prior authorization ,Retail pharmacy Additional Skills & Qualifications:… more
- CareOregon (Portland, OR)
- …of prior authorization and formulary exception decisions. + Perform prior authorization reviews with pharmacist oversight. Appeals and Grievances + ... process. + Follow policy & procedures to facilitate a resolution for prior authorization , formulary exception and coverage determinations requests. Notify… more
- US Tech Solutions (RI)
- …. **Experience:** - Minimum of 2 year of pharmacy technician experience **Skills:** Prior authorization PBM **Education:** Verified GED or High school ... and courteous phone assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and accurate documentation of… more
- US Tech Solutions (May, OK)
- …and courteous phone assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and accurate documentation of ... all clinical questions, escalations and judgement calls to the pharmacist team. The Rep I, Clinical Services will also...the leadership team. Work closely with providers to process prior authorization (PA) and drug benefit exception… more
- Actalent (Dallas, TX)
- …and notify providers and/or members * Respond to client inquiries regarding authorization approvals and PBM on-line applications * Refer coverage determination ... the Appeals department, you will primarily handle cases involving denied Prior Authorizations for Medicare and Medicaid patients. Your main responsibilities include… more
- Actalent (Raleigh, NC)
- …and notify providers and/or members * Respond to client inquiries regarding authorization approvals and PBM online applications * Refer coverage determination ... triage coverage determination requests submitted from providers and determine if a pharmacist review is required * Obtain verbal authorizations and request detailed… more
- Hackensack Meridian Health (Neptune, NJ)
- …or clinical) and facilitates delivery of completed prescriptions back to the patient prior to discharge. The Navigator ensures OBRA compliance by ensuring an offer ... Performs prescription order entry duties as necessary 4. Obtains patient authorization to process discharge prescriptions through the ambulatory pharmacy 5. Engages… more