Pharmacist - RPh Operations Advisor - Specialty Medical Prior Authorization Aetna
About the position The Clinical Pharmacist Advisor - Specialty Medical Prior Authorization role is an operational position focused on conducting clinical reviews of medical data to facilitate prior authorization for specialty medications. The pharmacist will utilize their clinical expertise to apply approved criteria for both prospective and concurrent reviews, while also providing support through inbound calls from physicians or members regarding their authorization statuses.
Responsibilities
- Collaborating with Technicians and Nurses to process authorization requests, including answering clinical questions and collecting necessary clinical/medical data for assessments.
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- Coordinating timely communication of case decisions to physicians, health plans, employers, patients, and other healthcare professionals following approval and denial management processes.
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- Handling inbound phone calls and escalations from physicians or patients regarding Prior Authorization.
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- Establishing and maintaining communication among the company, health plan, and employer group staff.
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- Maintaining professional and technical knowledge of drug and disease-states for the Specialty Medical programs administered within the Novologix platform.
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- Performing other related projects and duties as assigned, including on-call and after-hours pharmacist availability.
Requirements
- Prior authorization experience required.
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- Previous pharmacy experience in retail or hospital preferred.
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- Active state pharmacist license in good standing required.
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- Basic computer skills required.
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- Strong organizational skills, interpersonal skills, and attention to detail.
Nice-to-haves
- Minimum of 2-5 years experience preferred.
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- Experience using MS Office and other Windows-based applications.
Benefits
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