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Clinical Pharmacist Consultant
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Full-time
- This may include providing coverage recommendations for medications subject to prior authorization, appeals, retrospective claim reviews, and audits based on applicable medication coverage policies, member benefit contracts, and provider contracts.
- May be responsible for conducting prior authorization reviews and peer-to-peer conversations with external providers.
- Provide coverage recommendations for medications subject to prior authorization, appeals, retrospective claim reviews, and audits based on applicable medication coverage policies, member benefit contracts, and provider contracts.
- May empower Case Management to provide comprehensive member support.
- Knowledge of health plan and benefit design structures and application, Medicare/CMS regulations and applicability in administering the Medicare Product, and health care coding and payment systems (such as ICD-9, CPT, HCPCS, NDC).
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