Pharmacist at Pacer Group

Title - Pharmacist

Duration - 3 months

Shift - 9 am to 6 pm EST

Location – Remote TX

Responsibilities

• Reviews a completed prior authorization request received from the provider and/or reviews the pharmacy technician’s recommended denial, suggested formulary alternatives, comments and attachments for appropriateness.
• Verifies member’s ID number and date of birth.
• Verifies member’s eligibility in the appropriate health plan eligibility system.
• Records carrier and group number if applicable.
• Checks for previous prior authorization decisions.
• Verifies coverage in member’s prescription benefit when necessary.
• Verifies coverage in member’s health plan benefit when necessary.
• Evaluates prescription claim history.
• Reviews chart notes and/or lab values.
• Identifies provider specialty when appropriate.
• Applies Medical Policy Criteria to prior authorization requests.
• Evaluates whether request meets criteria for approval.
• Reviews the request using professional clinical judgment on a case by case basis. A pharmacist will review medication requests not addressed by P&T Committee criteria or guidelines, develop and draft criteria for the non-formulary medication requested.
• Researches and contributes drug references and clinical information to facilitate prior authorization review: directly to physicians via fax or phone encounter; or to pharmacy technicians via memo or on a personal level as an educational tool

Communicates with physicians regarding prior authorization:

o For a non-formulary drug

o Plan benefits, exclusions

o Quantity limits

o Age restrictions

o Formulary alternatives

Retrieves and collects data through available reporting resources (i.e. Discoverer, IT Department)

Compiles data for reporting purposes:

o Drug utilization of non-formulary drugs

o Overturned IPS recommended denials

o Audit pharmacy claims greater than $200.00

o Suggest addition or deletion of drugs to/from the formulary

o Updating qty/days or age limit ends

o Support National P&T Committee

o Other tasks which may arise during the performance of any of the above mentioned duties

Education/Certification Required:

Pharm D.

Licensure Required:

TX

• Must haves: At least one year of professional RPh experience

• Nice to haves: Some experience working in managed care, understanding of Medicare/Medicaid law

Performance indicators: Sign 85 – 100 cases daily

Top 3

• Self-Motivated/Good Time Management Skills
• Working Knowledge of Office Suite
• Goal Oriented