Pharmacist - RPh Operations Advisor - Specialty Medical Prior Authorization Aetna

Job Title: Pharmacist - RPh Operations Advisor - Specialty Medical Prior Authorization Aetna
Job Location: RI
Job Duration: 5-6 Months (possibility of extension)
Shift: 7:00am to 10:00pm CST - 8 hours/day
Training: M-F 8:00am - 4:30pm CST for 4 weeks
Payrate: $53.00/ hr on w2

Job Summary:

• The clinical pharmacist is an operation based role that conducts clinical reviews of medical data collected to perform prior authorization for specialty medications.
• The clinical pharmacist will apply clinical knowledge to plan approved criteria for prospective and concurrent reviews of cases.
• This role will work from Client supported systems and take inbound calls from physician or members regarding their pending, approved, or denied prior authorizations.

Duties:
This individual must have excellent interpersonal skills. Will be responsible for:

• Collaborates with the Technicians and Nurses to process authorization requests, 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. (15%)
• Handles inbound phone calls and escalations from physicians or patients regarding Prior Authorization (50%)
• Establishes and maintains communication among Client, health plan and employer group staff. (5%)
• Maintain professional and technical knowledge of drug and disease-states for the Specialty Medical programs administered within the client. (5%)
• Performs other related projects and duties as assigned including on call and after hours pharmacist availability could be required. (5%)

Experience:

• 2+ years of clinical experience with specialty medications or clinical review of prior authorization requests.
• Experience using MS Office and other Windows based computer applications, strong organizational skills, interpersonal skills, and detail orientation are important for this position.

Required Certification:

• Active pharmacist license in state of residence in good standing.

Education:

• Bachelor's degree in pharmacy or Pharm D. required with at least two years experience as a pharmacist.
• Must have an active license in good standing.