Job description

Position Title: Case Management Senior Manager

Hours: 9am -5:30pm M-F PST

Pay Rate: $60 /hr

Location: Teleworker based out of Rancho Cordova, Monterey Park, or Oakland, CA

Requirements:

· PharmD education required

· Active, unrestricted Pharmacist license required

· 1+ years clinical knowledge regarding therapeutic use of drugs.

· Familiarity with clinical compendia (Micromedex, Clinical Pharmacology, NCCN, AHFS, etc)

· 2+ years of Prior Authorization review experience.

· 2+ years of Pharmacy Benefit Manager (PBM)/Managed Care experience.

· Must have CVS COS system experience.

Job Description:

· Reviewing prior authorization requests, utilizing the approved clinical coverage criteria, for clinical appropriateness and medical necessity within the regulatory turnaround times.

· All prior authorization cases are reviewed by our pharmacy technicians and approved when possible utilizing the P&T approved coverage criteria.

· Any potential denials require a clinical review by a pharmacist before a final denial is sent to the provider/member.

· In addition, various potential approvals for high cost medications require a clinical review by a pharmacist.

· This position has been added to help support 2023 business needs.

#INDPM

Job Types: Full-time, Contract

Pay: $60.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Application Question(s):

• Do you have Familiarity with clinical compendia (Micromedex, Clinical Pharmacology, NCCN, AHFS, etc) ?

Education:

• Bachelor's (Required)

Experience:

• clinical knowledge regarding therapeutic use of drugs: 1 year (Required)
• Prior Authorization review: 2 years (Required)
• Pharmacy Benefit Manager (PBM)/Managed Care: 2 years (Required)
• CVS COS system: 1 year (Required)

License/Certification:

• Pharmacist (Preferred)

Work Location: Remote

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