Job Summary:Pharmacist I is responsible for supporting the department, operational strategies, goals and vision. Pharmacists shall utilize pharmaceutical and clinical expertise to review Prior Authorizations requests within a timely manner, to promptly serve our CareSource members.
Essential Functions:- Supports and participates in Prior Authorization (PA) Reviews by documenting, implementing and utilizing the following: Formulary Management guidelines, Utilization Management programs, CareSource Administrative and Operational policies and procedures, and/or other clinical programs
- Execute critical thinking and decision processes when evaluating PA Reviews for Pharmacy and Medical Benefit medications
- Conduct PA Reviews for Multi-State Medicaid and Marketplace lines of business
- Provide written communications to members and providers upon decisioning of PA requests
- Engage Providers in "Peer to Peer" discussions, and Clinical Consults, as requested
- Assist Pharmacy PA call center staff
- Provide support and collaborate with pharmacy technicians to ensure operational efficiencies
- Adhere to Turn Around Time (TAT) requirements, per Line of Business
- Observe Operational Productivity Goals and Metrics
- Maintain exceptional quality
- Cross-collaborate with Departmental and Organizational Teams
- Perform any other job duties as requested
Education and Experience:- Bachelor's Degree in Pharmacy is required; Doctor of Pharmacy (PharmD) is preferred
- Minimum of three (3) years of retail pharmacy experience is preferred
- Minimum of one (1) year managed care or Medicare experience is preferred
Competencies, Knowledge and Skills:- Working knowledge of Microsoft Outlook, Teams, Word, Excel, and PowerPoint
- Familiarity with the healthcare field, including Insurer, PBM, Specialty or Retail Pharmacy and Provider
- Understanding Managed Care and/or Retail Pharmacy operations with respect to Medicaid, Marketplace and /or Medicare
- Proficient in medical terminology, medication names, generics and biosimilars
- Application of Clinical guidelines, policies, and decision trees/tools
- Understanding the pharmacist's clinical role in the care of members; utilization of Clinical expertise
- Strong written and verbal Communication skills, including use of proper grammar in print and e-mail communications
- Ability to simplify clinical language for lay persons
- Critical listening, thinking and problem-solving skills
- Attention to detail
- Organized and learns quickly
- Comfortable working in a fast-paced environment
- Time management skills
- Use of proper phone etiquette
- Ability to work independently and within a team environment
Licensure and Certification:- Current, unrestricted Registered Pharmacist (RPh) licensure is required
- Ability to acquire additional State License(s) in multiple states, as required
Working Conditions:- General office or Remote work environment; may be required to sit or stand for extended periods of time
Compensation Range:$94,100.00 - $164,800.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):Salary
Organization Level Competencies - Fostering a Collaborative Workplace Culture
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time.#LI-JM1
Brand=CareSource
