- Molina Healthcare (Mesa, AZ)
- …/health plan providers, Molina staff and others as needed. * Performs prior authorization reviews of high-cost medications and deferred authorization ... JOB DESCRIPTION **Job Summary** Provides support and subject matter expertise for pharmacy Medication Therapy Management (MTM) and clinical pharmacy services… more
- US Tech Solutions (May, OK)
- …procedure. **Skills:** + Managed Care exp and Medicare/Medicaid knowledge Counseling + Prior Authorization + Pharmacy Benefit Management **Experience:** + ... Previous pharmacy experience in PBM or Prior Authorization . + Appropriate state license required. + Basic computer skills required. Strong organizational… more
- Actalent (Sacramento, CA)
- … pharmacy knowledge and expertise. + Strong understanding of drug products and prior authorization processes. + Active pharmacy license in good standing. ... 100% Remote Pharmacist Responsibilities + Conduct drug utilization reviews...ensure compliance with state and federal regulations. + Manage prior authorizations effectively. + Educate healthcare providers on appropriate… more
- Molina Healthcare (Iowa City, IA)
- …those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs ... **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services/Management staff work to ensure that Molina...responsible for creating, operating, and monitoring Molina Health Plan's pharmacy benefit programs in accordance with all federal and… more
- Prime Therapeutics (Lansing, MI)
- …processing and documenting of Utilization Management requests (ie formulary exceptions, prior authorization , step therapy, quantity limit exceptions) for ... + Responsible for the clinical evaluation for coverage determination requests for prior authorization (PA) or other utilization management (UM) programs,… more
- Actalent (Sacramento, CA)
- …clinical pharmacy knowledge. + Experience with drug product knowledge. + Prior authorization experience. Additional Skills & Qualifications + At least 1 ... and knowledgeable pharmacist to conduct drug utilization reviews and manage prior authorizations in compliance with state and federal regulations. This role… more
- IQVIA (Raleigh, NC)
- …correct eligibility information, perform benefit investigations, copay assistance and check prior authorization and/or appeal status. Care Managers may also ... breakthroughs in the real world. **Position Summary:** AllCare Plus Pharmacy , an IQVIA company, is seeking a Care Manager!...assistance programs and/or varied adherence support. This is a ** remote ** position. **Hours:** Must be available for an 8… more
- Sharp HealthCare (San Diego, CA)
- …encompasses a patient centered care management approach that includes referral management, prior authorization , Case Management and Disease Care Management and ... for the execution and coordination of all ACM activities including Pharmacy . Helps to plan, develop, organize, monitor, communicate and recommend modifications… more
- KPH Healthcare Services, Inc. (Syracuse, NY)
- …+ Responsible for contacting members and prescribers on non-covered items + Facilitate prior authorization process for customers + Provide clinical services in ... **Educational Requirements:** + Minimum: High School Diploma or GED + Preferred: Pharmacy technician or related certification **Experience:** + Past experience in a… more
- CVS Health (Phoenix, AZ)
- …professional and courteous phone assistance to all callers through the criteria based prior authorization process. Certified Pharmacy Technicians (CPhT) are ... attention to detail and the ability to multi-task effectively. ** Remote Work Requirements:** + Prior remote...I, Level II, and Level III positions within the Prior Authorization (PA) team is a structured… more