· 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 Medicare D cases.
· This role will work from Client Caremark supported systems and make outbound calls to physician or members regarding their pending, approved, or denied prior authorizations.
· This is a production environment with production and quality goals on set ramp targets.
· 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
· Minimum 1 year of experience although 2-5 years is preferred
· Bachelor's degree Required, Pharm D Preferred
· Verifiable High School diploma or GED is required.
As an equal opportunity employer, ICONMA prides itself on creating an employment environment that supports and encourages the abilities of all persons regardless of race, color, gender, age, sexual orientation, citizenship, or disability.