Are you an experienced Case Management with a desire to excel? If so, then Talent Software Services may have the job for you! Our client is seeking an experienced Case Management to work at their company in CA(100% remote).
Primary Responsibilities/Accountabilities:
- The day-to-day job responsibilities in this role include utilizing the client's P&T-approved clinical coverage criteria to review prior authorization requests for clinical appropriateness and medical necessity within regulatory turnaround times.
- Cases are prepared by our intake staff and pharmacy technicians before being sent to a pharmacist for final review. Notifications regarding the determination are sent to the provider and member. This position supports ongoing 2024-2025 business needs.
Qualifications:
- Knowledge of clinical pharmacology. Ability to interpret clinical charts and labs.
- Excellent oral and written communication skills.
- Proficiency with clinical compendia (Micromedex, Clinical Pharmacology, NCCN, AHFS, etc).
- CA Board of Pharmacy Registered Pharmacist with a Clear license
- PharmD
Preferred:
- Prior Authorization review experience.
- Experience with and/or knowledge of specialty and injectable medications.
- Completion of residency program.