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Performs prior approval reviews of pharmacy services in accordance with State Guidelines.
Essential Job Functions
Provides expertise in prior approval pharmacy services.
Recognizes, evaluates, interprets, recommends and implements policies and procedures for specific components of pharmacy services
Reviews and incorporates health and medical surveillance standards as defined and recommended by the Occupational Safety and Health Administration (OSHA) and other governmental and legal agencies; ensures company safety standards adhere to established guidelines.
Adhering to all HIPAA requirements by keeping any and all information related to work with the a Medicaid program confidential at all times, including, but not limited to, items such as recipient numbers, birth dates, social security numbers, names and addresses, etc..
Review prior authorization requests and make determinations for drug products according to benefits and coverage criteria
Provide clinical guidance and support to the assigned pharmacy technicians
Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practices
Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
Qualifications
Basic Qualifications
Bachelor of Science Degree in Pharmacy from an accredited institution; Advanced degree and/or residency preferred
1-2 years relevant experience
Experience in managed care and/or prior authorization highly preferred
Flexibility to work rotating shifts = Monday –
Friday, between the hours of 7:00 am – 11:00 pm; Saturdays and Sunday 7:00-6:00pm
Current pharmacist licensure to practice without restrictions
PC skills in a Windows based environment
Strong communication skills, oral and written
Seven or more years of medical experience
CSC is an Equal Opportunity/Affirmative Action employer. All qualified candidates will receive consideration for employment without regard to disability, protected veteran status, race, color, religious creed, national origin, citizenship,
marital status, sex, sexual orientation/gender identity, age (40 or over), or genetic information. CSC’s commitment to diversity and inclusive selection practices includes ensuring qualified long-term unemployed job seekers receive equal
consideration for employment.
AppLabs – 2 days ago
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