Massachusetts Jobs

Note: Candidate needs to have Prior Authorization & Utilization Management experience.

• Under the direction of the Pharmacy Utilization Management (UM) Supervisor, the Clinical Pharmacist is responsible for reviewing, processing and managing the daily caseload of pharmacy and medical prior authorization (PA) requests for coverage determinations and exceptions. The Clinical Pharmacist ensures timely disposition of PA reviews by adherence to established timeframes.

Responsibilities:

• Performs case reviews in automated prior authorization tools and guides the case through the entire process to either approval or denial to ensure all coverage determinations and notices are consistent with applicable regulatory and accreditation requirements and turnaround times

• Provides all aspects of clinical support needed to perform drug prior authorization (PA) requests and consults as required with Medical Directors on cases that fail to meet coverage criteria

• Communicates daily with providers and other external customers regarding status and disposition of cases

• Oversees and addresses any quality issues with pharmacy technicians and confer with other clinical pharmacist on review questions

• Communicate with UM staff and providers when issues arise regarding policy interpretation, potential access availability or other quality assurance issues to ensure that members receive coverage determinations within timelines developed by all accrediting and regulatory guidelines

• Performs other roles/duties and projects as assigned by the Pharmacy UM Supervisor(s)

Experience:

• 2-5 years of experience within Utilization Management & Prior Authorization experience in a managed care setting.

• Experience as a Clinical Pharmacist is mandatory.

• Must be a licensed pharmacist with good standing with Board of Pharmacy

Education:

• Bachelors degree or equivalent experience

About US Tech Solutions:

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com (http://www.ustechsolutionsinc.com) .

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.