Pharmacy Healthcare Consultant / Insurance

DXC Technology   •  

Madison, WI

Industry: Professional, Scientific & Technical Services

  •  

Not Specified years

Posted 164 days ago

This job is no longer available.

Job Description:

The Pharmacy Consultant will review Medicaid Prior Authorizations based on medical necessity in accordance with State policy guidelines, provide guidance and support for Medicaid Providers when appropriate, and act as a clinical SME (or liaison) for internal DXC entities. Note: This is not a patient facing position.

Primary Job Responsibilities:

  • Adjudicating pharmacy prior authorizations based on medical necessity and eligibility, in accordance with State policy guidelines and accepted pharmacy practices.
  • Reviewing and evaluating prior authorization submissions utilizing multiple computer systems, and when appropriate seeking additional information or clarification from requesting Provider
  • Entering prior authorization outcome into the Medicaid Management Information System (MMIS) for processing.
  • Participation in monthly meetings which include DXC leadership, operational staff support, clinical peers and State stakeholders.
  • Providing assistance and education to the provider community related to specific prior authorization submissions, when applicable.
  • Offering analysis and recommendations to DXC and State leadership on methods and potential process improvements related to the administration and application of the pharmacy program.
  • Review communications to providers and members on new/revised policies.

Minimum Qualifications:

•Must be a graduate of a recognized and accredited School of Pharmacy

•Must be a registered pharmacist in the State of Wisconsin

•Must have professional knowledge of medication, supplies, and equipment used

•Medication knowledge must be current

•Ability to maintain a good working relationship with professional and non-professional people

•Must have ability to make judgments and decisions as necessary in areas of procedures and appropriateness of drug therapy

•Must be able to set priorities

Education:

PharmD degree is required for this position.

Licenses and Certifications:

Minimum - Licensed to practice pharmacy in the State of Wisconsin

Required Skills, Knowledge, and Abilities:

  • Ability to make judgments in demanding situations
  • Ability to react to frequent changes in duties and volume of work
  • Ability to logically organize details
  • Comfortable accepting responsibility for medium to large scale projects involving multiple resources and spanning many months from start to finish
  • Ability to manage multiple concurrent activities
  • 51143249