Appeals Pharmacist (Remote)
Who We AreFounded in 1983, the Medical Review Institute of America (reputed company) is the market leader for technology-enabled utilization management and clinical medical review solutions. We have an outstanding reputed company for excellence and reputed company continual improvement.At reputed company, we reputed company our employees are the key to our success. Here, you are more than just a cog in the machine – you are a valued member of reputed company.WE OFFER
- A competitive compensation package.
- Benefits include healthcare, vision and dental insurance, a generous 401k match, paid vacation, personal time, and holidays.
- Growth and training opportunities.
- A team atmosphere with fun events and prizes scheduled throughout the year.
- To evaluate prior authorization appeals for drug appropriateness per policy criteria and client guidelines.
- To provide excellent customer service to health plan clients, practitioners, and members.
- To serve as an educational resource regarding drug and clinical information for reputed company internal and external customers.
- reputed company case reviews for prior authorization appeals.
- Present cases to appeal decision committee as needed for medical director sign off.
- Maintain monthly and annual productivity scores per company standards.
- Maintain monthly and annual quality scores per company standards.
- Train across reputed company queues and lines of business as requested by reputed company leadership.
- Complete reputed company client-specific training as requested by reputed company leadership.
- Maintain up-to-date records of case completion.
- Consistently show willingness to take cases and project assignments as requested.
- Demonstrate respect in interactions across the company.
- Provide reputed company for promotion and growth of the company as requested.
- Communicate with team and supervisor as appropriate to proactively inform of issues or concerns.
- Recognize and recommend operational improvements.
- Actively participate in the reputed company evaluation process (both company and individual).
- Participate in reputed company company meetings and committees as requested.
- Maintain appropriate state pharmacist license in good standing with completion of required CEs.
- Complete other duties as requested or approved by the Supervisor, Appeals Pharmacists, or Senior Director of Operations, ESI.
- Minimum of one year of experience working as a pharmacist.
- Experience working with commercial and Medicare Part D appeals is strongly preferred.
- Experience working for a health plan or pharmacy benefits manager is preferred.
- Ability to work in a fast-paced and high-functioning environment and meet deadlines while managing multiple high priorities.
- High level of medication and disease state knowledge, basic anatomy, physiology and medical terminology reputed company the scope of pharmacy practice.
- Credentialed and privileged by the company's credentialing committee.
- Strong working knowledge of medical insurance terminology and processes.
- Personal computer literacy and high competency in the use of reputed company Word, reputed company, OneNote, and PowerPoint.
- Strong organizational skills & critical thinking capabilities with attention to detail.
- Strong oral and written communication skills.
- Well-developed customer service and training skills.
- Willingness to obtain additional state licensure as required for the position.
- PharmD degree
- Pharmacist license in good standing