Job Description

Job Description:

Job Title: Pharmacist 1

Duration: 6 months (Possible Extension)

Location: Remote

Shift: Monday Friday 9 6 p.m. EST (Team is currently on rotating weekend schedule (once every 6 8 weeks) on call not strict hours),

Description:

Walk me through the day-to-day responsibilities of this the role and a description of the project (Outside of Workday JD):

• Work performed will be clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards.
• Pharmacist will evaluate Health Plan Appeals for either overturning the decision or upholding the denial by the PBM. The pharmacist will work through the entire appeals process as it pertains to the clinical pharmacist role at the Health Plan.

Describe the performance expectations/metrics for this individual and their team:

• The expectation will be weekend work and well as the completion of at least 7 appeals per workday once fully trained.

Tell me about what their first day looks like:

• The first day will consist of team introductions as well as Centene based training. Once those trainings are complete, the pharmacist will chairside train with a resident Clinical Pharmacist.

What previous job titles or background work will be in this role?

• Must have Appeals experience, Prior Authorization

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