Prior Authorization Pharmacist - REMOTE

PRIOR AUTHORIZATION PHARMACIST - REMOTE

ROLE AND RESPONSIBILITIES

The Prior Authorization Pharmacist is responsible for the day-to-day operation of the PA team. The PA Pharmacist will ensure that all authorizations to the team, are accurately obtained and reviewed in a timely manner. The PA Pharmacist will report directly to the Prior Authorization Manager.

• Manages the assigned daily work queues within prior authorization system PAHub.
• Ability to navigate other systems to assist with prior authorization review (drug information resources, clinical guidelines, claim system, benefit design system).
• Assists manager with overseeing prior authorization technicians.
• May review and approve or deny coverage for pharmaceuticals based on guideline-based prior authorization criteria, and coordinates with the Clinical team, Account Management and others as needed.
• Serves as a clinical resource to other pharmacists.
• May be responsible for assisting manager with development or updating of prior authorization criteria.
• Involved with the review of prior authorizations to support the overall management of client member medication access.
• Communicates process improvements as appropriate/approved to the team leader.
• Assumes ownership of assigned tasks, prioritizes work with/without leader input and moves projects to completion (in a timely manner).
• Participates in projects and/or meetings as assigned by manager.
• Attends additional training, performs research, e-learning to stay current on best practices and new practice management technology and functionality as it becomes available.
• Abide by all obligations under HIPAA related to Protected Health Information (PHI).
• If a HIPAA violation is discovered, whether individually or by another, you must report the violation to the Compliance Officer and/or Human Resources.
• Attend, complete, and demonstrate competency in all required HIPAA Training offered by the company.
• Flexibility to understand, appreciate and embrace that this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee.  Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.
• WHAT WE HAVE TO OFFER
• Our benefits package is designed to keep our employees happy and health - physically, mentally and financially.
• Medical, Dental Vision Insurance
• Disability and Life Insurance
• Employee Assistance Program
• Remote Work Options
• Generous Paid-Time Off
• Annual Reviews and Development Plans
• Retirement Plan with company match immediately 100% vested.
• REQUIRED SKILLS AND COMPETENCIES
• Pharmacist license in good standing.
• Maintains continuation education requirements.
• Supervisory Responsibility

None.

POSITION TYPE AND EXPECTED HOURS OF WORK

• Full-time, salary/exempt position.
• Some flexibility in hours is allowed, but the employee must be available during the “core” work hours of 8:00AM to 5:00PM CT.  We cover clients from West to East Coast, work times must be adjusted to cover meetings in all time zones.  Ability to work extended hours, weekends and holidays pursuant with industry demands.

TRAVEL

No travel expected for this position.

REQUIRED EDUCATION AND EXPERIENCE

• BS Pharm OR PharmD required.
• Managed Care experience required.
• Prior authorization review experience required.
• PREFERRED EDUCATION AND EXPERIENCE
• Past use of PAHub preferred.

Liviniti, LLC and all entities provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, or genetics. In addition to federal law requirements, Liviniti complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Liviniti expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Liviniti employees to perform their job duties may result in discipline up to and including discharge.  EOE M/F/V/D