Prior Authorization Pharmacist Job at Pride Health, Colorado

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  • Pride Health
  • Colorado

Job Description

Pride Health is hiring remote contract to hire Prior Authorization Pharmacists in MST/PST time zones! Candidates must live in one of the following states: Nevada, Arizona, New Mexico, Utah, Montana, Idaho, Oregon, and Colorado. This is a call center business segment. The pharmacist’s primary role is reviewing Prior Authorization cases and rendering coverage determinations based on clinical criteria and plan design in a fast-paced and dynamic environment.

Schedule: Will work 8-hour days 5 days a week which may or may not include a weekend day(s), and must be available as early as 5 am and as late as midnight.

Pay: $54-$62 hourly

Primary Responsibilities:

• Establish and process member prescriptions or prior authorizations through various computer systems ensuring the accuracy of all data and updating as necessary.

• Work is computer-based and includes receiving phone calls from prior authorization pharmacy technicians and/or providers for clinical information.

• Consult physicians/providers with questions, interpret clinical guideline criteria, and render/review coverage determination for prior authorization cases.

• Consult with pharmacy technicians and/or physicians regarding the use of medications and advise of appropriate formulary alternatives when requested.

• Gather complex clinical information, coverage policy, and criteria information and work within regulatory guidelines to make coverage determinations.

• Perform all duties and functions in compliance with state and federal pharmacy laws and regulations

• Conform with and support department quality assurance and improvement guidelines.

Requirements:

  • Active Pharmacist License in good standing within the state of residence (NV, AZ, NM, UT, MT, ID, OR, and CO)
  • Prior Authorization experience preferred

Apply today!

Pride Global offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.

Job Tags

Hourly pay, Contract work, Remote job, Night shift,

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