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Job Description

The Remote Clinical Pharmacist position provides clinical guidance and support to our Member Advocates and Account Executives. You will also be responsible for reviewing prior authorization requests in accordance with member benefits and coverage criteria within defined turn-around times.

Review of prior authorization requests in accordance with member benefits and coverage criteria within defined turn-around times.

Review prior authorizations and determine opportunities for interventions.

Coordinate appeals.

Provide clinical guidance and support to member advocates and account executives.

Work with prescriber to provide other clinically equivalent but cost-effective alternatives.

Receive/make phone calls from/to providers or members for clinical information and consulting.

Analyze data to identify drug utilization trends and cost-savings opportunities.

Generate and analyze prior authorization reports as well as other drug related reports.

Continuously work to streamline and improve the quality of the prior authorization and drug utilization management processes.

Motivates and works with clinical staff to ensure that performance standards are met or exceeded.

Ensures clinical staff are appropriately educated on new programs, procedures, etc.

Assist with other duties and special projects as assigned.

Uphold compliance standards relating to HIPAA and Department of Labor guidelines when corresponding with providers and maintaining documentation.

Maintain confidentiality of sensitive information.

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to [email protected] learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.

Skills and Requirements

S. in Pharmacy or Doctor of Pharmacy (Pharm.D) degree

Active, current and unrestricted pharmacist license/registration

1+ year of direct prior authorization experience

Working knowledge of MediSpan data system, including GPI drug classification

Excellent communication and interpersonal skills, written and verbal, with the ability to adapt appropriately for different audiences

Able to multi-task effectively and transition between tasks frequently

Able to maintain focus when presented with interruptions

Proactive problem-solving skills

Proficient computer skills, including Microsoft Office Suite

Team-first mindset with a high level of motivation and drive

Persistent with a drive to see tasks through when objectives are not met on the first try

Passionate and proactive about contributing to organizational missions focused on improving member experiences

Ability to remain calm and work efficiently in a fast-paced environment

Ability to travel to Texas office once a quarter Active pharmacist license in the state of Texas