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REMOTE - Pharmacist I - R8621

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CareSource

2mo ago

  • Job
    Full-time
    Mid Level
  • Legal
    Healthcare
  • United States
    Remote

AI generated summary

  • You must have a Bachelor's in Pharmacy, 3 years of retail experience, 1-year managed care experience, RPh licensure, strong communication, and time management skills, plus proficiency in Microsoft Office.
  • You will evaluate Prior Authorization requests, communicate decisions, engage providers, assist call center staff, ensure operational efficiency, and maintain quality while meeting productivity goals.

Requirements

  • Bachelor’s Degree in Pharmacy is required; Doctor of Pharmacy (PharmD) is preferred
  • Minimum of three (3) years of retail pharmacy experience is preferred
  • Minimum of one (1) year managed care or Medicare experience is preferred
  • Current, unrestricted Registered Pharmacist (RPh) licensure is required
  • Ability to acquire additional State License(s) in multiple states, as required
  • Working knowledge of Microsoft Outlook, Teams, Word, Excel, and PowerPoint
  • Familiarity with the healthcare field, including Insurer, PBM, Specialty or Retail Pharmacy and Provider
  • Understanding Managed Care and/or Retail Pharmacy operations with respect to Medicaid, Marketplace and /or Medicare
  • Proficient in medical terminology, medication names, generics and biosimilars
  • Application of Clinical guidelines, policies, and decision trees/tools
  • Understanding the pharmacist’s clinical role in the care of members; utilization of Clinical expertise
  • Strong written and verbal Communication skills, including use of proper grammar in print and e-mail communications
  • Ability to simplify clinical language for lay persons
  • Critical listening, thinking and problem-solving skills
  • Attention to detail
  • Organized and learns quickly
  • Comfortable working in a fast-paced environment
  • Time management skills
  • Use of proper phone etiquette
  • Ability to work independently and within a team environment
  • General office or Remote work environment; may be required to sit or stand for extended periods of time

Responsibilities

  • Supports and participates in Prior Authorization (PA) Reviews by documenting, implementing and utilizing the following: Formulary Management guidelines, Utilization Management programs, CareSource Administrative and Operational policies and procedures, and/or other clinical programs
  • Execute critical thinking and decision processes when evaluating PA Reviews for Pharmacy and Medical Benefit medications
  • Conduct PA Reviews for Multi-State Medicaid and Marketplace lines of business
  • Provide written communications to members and providers upon decisioning of PA requests
  • Engage Providers in “Peer to Peer” discussions, and Clinical Consults, as requested
  • Assist Pharmacy PA call center staff
  • Provide support and collaborate with pharmacy technicians to ensure operational efficiencies
  • Adhere to Turn Around Time (TAT) requirements, per Line of Business
  • Observe Operational Productivity Goals and Metrics
  • Maintain exceptional quality
  • Cross-collaborate with Departmental and Organizational Teams
  • Perform any other job duties as requested

FAQs

Do we support remote work?

Yes, this position is designed for remote work.

What type of degree is required for this position?

A Bachelor’s Degree in Pharmacy is required; a Doctor of Pharmacy (PharmD) is preferred.

How many years of retail pharmacy experience is preferred?

A minimum of three (3) years of retail pharmacy experience is preferred.

Is managed care experience needed for this role?

Yes, a minimum of one (1) year of managed care or Medicare experience is preferred.

What kind of experience is necessary for this position?

Experience in retail pharmacy and familiarity with managed care or Medicare is necessary.

What skills are important for this job?

Critical listening, thinking, problem-solving skills, strong written and verbal communication skills, and attention to detail are important.

What are the key responsibilities of a Pharmacist I?

Key responsibilities include conducting Prior Authorization reviews, communicating decisions to members and providers, engaging in peer discussions, and maintaining quality and productivity standards.

Is a specific licensure required for this position?

Yes, a current, unrestricted Registered Pharmacist (RPh) licensure is required.

Are there opportunities for professional development in this role?

Yes, the company encourages employees to pursue personal excellence and develop themselves and others.

What is the compensation range for this position?

The compensation range is $83,070.00 - $145,440.00, depending on education, training, and experience.

Does CareSource promote an inclusive work environment?

Yes, CareSource is dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.

Will I need to work independently or in a team?

This position requires the ability to work both independently and within a team environment.

Finance
Industry
1001-5000
Employees

Mission & Purpose

Health Care with Heart. It is more than a tagline; it’s how we do business. CareSource has been providing life-changing health care to people and communities for 30+ years and we continue to be a transformative force in the industry by placing people over profits. CareSource is and will always be member-first. Even as we grow, we remember the reason we are here – to make a difference in our members’ lives by improving their health and well-being. Today, CareSource offers a lifetime of health coverage to over 2.3 million members through plan offerings including Marketplace, Medicare products and Medicaid. With our team of 4,500+ employees located across the country, we continue to clear a path to better life for our members. Visit the "Life"​ section to see how we are living our mission in the states we serve.