Remote PBM Prior Authorization Pharmacist (Must live in NC)

Job Title: Remote PBM Prior Authorization Pharmacist Pay: $53 an hr | Bi-weekly Job Type: Remote in North Carolina. MUST LIVE IN NORTH CAROLINA Shift Options: Monday through Friday from 11am - 730pm EST Remote PBM Prior Authorization Pharmacist Overview: This position is for a Clinical Pharmacist working in the Prior Authorization team. Candidate must hold active pharmacist licensure in the State of North Carolina. 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. • Collaborate with the technicians and prior authorization team members to process referrals, including answering clinical questions and 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. Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations. • Maintain professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered within the Medicaid, Commercial Prior Authorization and Case Review Unit (CRU) line of business. • Perform other related projects and duties as assigned, including attending training sessions and development meetings, and providing on-call and after-hours pharmacist availability as needed. Remote PBM Prior Authorization Pharmacist Qualifications: • Active, unrestricted pharmacist license that is in good standing in the state of North Carolina • Demonstrated experience using clinical resources, e.g., Micromedex, Lexicomp, Clinical Pharmacology ***Call center and clinical pharmacy experience. • Ability to prioritize, quickly assess, manage multiple tasks and adapt to constantly changing situations. • Excellent organizational skills. Strong detail orientation. • Strong Microsoft Office skills. • Excellent oral and written communication skills and interpersonal skills. • Ability to work independently and make clinical decisions. • Experience using MS Office and other Windows based computer applications. • Ability to receive phone calls from prior authorization pharmacy technicians and/or providers for clinical information. Remote PBM Prior Authorization Pharmacist Benefits: Benefits are available to full-time employees after 90 days of employment and include health, optical, dental, life, and short-term disability insurance. A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates. How to Apply: If you are interested in this position, please apply OR submit your resume to: Saw Hlaing | shlaing@alinestaffing.com | 412-790-5425