Description:
Position Summary
- As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits.
- You will be responsible for ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to providers for more information when needed, and ensuring accurate decisions that comply with compendia and Medicare guidance and timelines.
- This is a great opportunity to initiate a career with a leading healthcare company by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience.
Duties
Responsibilities
- Collaborates with multiple groups within CD&A, including answering clinical questions, collecting appropriate clinical/ medical data needed to perform clinical assessments, and reviews as per the health plan/employer agreed criteria within the designated service level agreements. (20%)
- Coordinates timely communication of case decision to physician, health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes. (20%)
- Reviews cases in progress and provides a Clinical decision regarding Prior Authorizations, Tier Exceptions and Non-Formulary requests (50%)
- Performs other related projects and duties as assigned including on call and after hours pharmacist availability could be required. (10%)
- Knowledge of Access, Power Point, and Visio is preferable.
- Must be computer literate – knowledge of Excel and Word.
- Licensed Registered Pharmacist in state of residence
Experience
- Minimum 1 year of experience although 2-5 years is preferred
License
Pharmacist
Education
Bachelor's Degree Required, Pharm D Preferred
Note :
- 8am to 8pm EST/CST - 8hours per day M-F or 7am-330p EST/CST rotating weekends . Fully remote (never coming onsite) .
- Attendance is extremely important, especially during the initial 8 weeks of training. The new hire must be available M-F from 9am-5:30pm EST for the first 8 weeks (no vacation time planned). All time off needed should be discussed and disclosed during this initial review.
- After training, our hours of operation are 8-8 EST/CST M-F with rotating weekend schedules. – they must be available for the rotating weekend.
- This is a work from home (WFH) position; must have a dedicated quiet, separate space in which to work with wired internet meeting 25mbps min download and 5mbps minimum upload speed. Previous WFH experience is preferred.
- Must be able to sit and focus on work for the duration of shift.
- Data entry and navigating multiple computer applications while utilizing two screens is the primary function of job (possible outbound calls needed). A job history demonstrating this is recommended.
- Active Pharmacist license is required in the state you live in.
- Successfully worked independently in a data entry, productivity driven role is preferred
- As a company we strive for a team that is engaged and positive so candidates that demonstrate this would be ideal
- Safety Sensitive Role
- Must provide a copy Registered Pharmacist License .
- Include a screenshot of license and internet speed.
- Verifyable High School Diploma or GED Required
Job Type: Contract
Pay: $50.00 - $51.58 per hour
Expected hours: 40 per week
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Education:
Experience:
- Pharmacist: 1 year (Preferred)
License/Certification:
- Registered Pharmacist (Required)
- Licensed Pharmacist (Required)
- Certified Pharmacist (Preferred)
Work Location: Remote