Staff Pharmacist - Prior Authorization-Pharmacy Retail Set

Location : Valley View

Biweekly Hours : 80.00

Shift : Monday thru Friday 7a-7p rotating

The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being : affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help and other services. The system strives to become as good at preventing disease as it is at treating it. Founded in 1837, Cuyahoga County's safety-net health system operates four hospitals, four emergency departments and more than 20 health centers.

Summary :

Processes and obtains authorizations for medication therapy requests initiated by MetroHealth Clinicians. Serves as a primary contact for Retail Pharmacy benefits verifications and payor preauthorization. Provides clinical oversight for Prior Authorization Specialists and is a resource for providers for recommendations on drug therapy changes. Follows up with and resolves issues related to authorizations. Implements denial management protocols as directed. Implements / maintains programs that reduce drug expenses for uninsured and under-insured patients, including through reimbursements of specific drug products, and by assisting patients in accessing pharmaceutical manufacturer patient assistance programs. Ensures that the current Federal, State and other regulatory agencies' requirements are followed. Upholds the mission, vision, values, and customer service standards of The MetroHealth System.

Qualifications : Required :

Bachelor of Science degree in Pharmacy from a State of Ohio Board of Pharmacy approved institution.

Possesses a current Pharmacist License from the State of Ohio Board of Pharmacy.

Possesses a current Pharmacy-Based Immunization Delivery certificate from the American Pharmacist Association (APhA), or an equivalent certification from a program recognized by the State of Ohio Board of Pharmacy.

Possess a current Basic Life Support (BLS) certification from the American Heart Association (AHA) or obtains within 90 days of hire.

Meets one of the following :

• 1 year of experience with prior authorization practices or within a Pharmacy Benefit Manager practice.
• 2 years of experience with pharmacy dispensing activities in a hospital or retail pharmacy.
• 2 years of experience in hospital billing and / or reimbursement.

Knowledge of pharmaceutical reimbursement requirements, principles, and best practices.

Proficient personal computer skills, especially with the Microsoft Office Suite of software including Excel and Word.

Strong written, verbal, and interpersonal communication skills, including the ability to communicate effectively with a diverse patient population in a variety of settings.

Strong customer service skills.

Strong analytical and decision-making skills.

Solid critical thinking and organizational skills.

Ability to work independently and as a member of a team with a high degree of flexibility.

Knowledge of medical terminology.

Ability to interact effectively with a wide range of cultural, ethnic, racial, and socioeconomic backgrounds.

Preferred :

Pharm.D. degree from a State of Ohio Board of Pharmacy approved institution.

Completion of an American Society of Health-Systems Pharmacists (ASHP) accredited residency.

Demonstrated effectiveness in time management, support staff supervision, problem identification / resolution, and decision-making.

Experience with EPIC.

Experience with CoverMyMeds or other prior authorization process automation tools.

Knowledge of regulations and requirements for government agencies, insurance carriers, and pharmaceutical manufacturers as they relate to medication assistance programs.

Physical Requirements : May sit, stand, stoop, bend, and ambulate intermittently during the day. May need to sit or stand for extended periods.See in the normal visual range with or without correction.Hear in the normal audio range with or without correction.Finger dexterity to operate office equipment required. May need to lift up to twenty-five (25) pounds on occasion.Ability to communicate in face-to-face, phone, email, and other communications.Ability to see computer monitor and departmental documents.