Job Summary:
Pharmacist I is responsible for supporting the department, operational strategies, goals and vision. Pharmacists shall utilize pharmaceutical and clinical expertise to review Prior Authorizations requests within a timely manner, to promptly serve our CareSource members.
Essential Functions:
- Supports and participates in Prior Authorization (PA) Reviews by documenting, implementing and utilizing the following: Formulary Management guidelines, Utilization Management programs, CareSource Administrative and Operational policies and procedures, and/or other clinical programs
- Execute critical thinking and decision processes when evaluating PA Reviews for Pharmacy and Medical Benefit medications
- Conduct PA Reviews for Multi-State Medicaid and Marketplace lines of business
- Provide written communications to members and providers upon decisioning of PA requests
- Engage Providers in “Peer to Peer” discussions, and Clinical Consults, as requested
- Assist Pharmacy PA call center staff
- Provide support and collaborate with pharmacy technicians to ensure operational efficiencies
- Adhere to Turn Around Time (TAT) requirements, per Line of Business
- Observe Operational Productivity Goals and Metrics
- Maintain exceptional quality
- Cross-collaborate with Departmental and Organizational Teams
- Perform any other job duties as requested
Education and Experience:
- Bachelor’s Degree in Pharmacy is required; Doctor of Pharmacy (PharmD) is preferred
- Minimum of three (3) years of retail pharmacy experience is preferred
- Minimum of one (1) year managed care or Medicare experience is preferred
Competencies, Knowledge and Skills:
- Working knowledge of Microsoft Outlook, Teams, Word, Excel, and PowerPoint
- Familiarity with the healthcare field, including Insurer, PBM, Specialty or Retail Pharmacy and Provider
- Understanding Managed Care and/or Retail Pharmacy operations with respect to Medicaid, Marketplace and /or Medicare
- Proficient in medical terminology, medication names, generics and biosimilars
- Application of Clinical guidelines, policies, and decision trees/tools
- Understanding the pharmacist’s clinical role in the care of members; utilization of Clinical expertise
- Strong written and verbal Communication skills, including use of proper grammar in print and e-mail communications
- Ability to simplify clinical language for lay persons
- Critical listening, thinking and problem-solving skills
- Attention to detail
- Organized and learns quickly
- Comfortable working in a fast-paced environment
- Time management skills
- Use of proper phone etiquette
- Ability to work independently and within a team environment
Licensure and Certification:
- Current, unrestricted Registered Pharmacist (RPh) licensure is required
- Ability to acquire additional State License(s) in multiple states, as required
Working Conditions:
- General office or Remote work environment; may be required to sit or stand for extended periods of time
Compensation Range:
$90,500.00 - $158,400.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.