Job description
Details
Department: Pharmacy Administrative Support
Benefits
Paid time off (PTO)
**Benefits can vary. Please note, your Talent Advisor can provide specifics to the role should you have questions.
Responsibilities
The Pharmacist Prior Authorization Specialist will retrieve, review and analyze pharmacy utilization and clinical appropriateness data based on plan criteria. Determine participation and coverage for pharmacy and medical plan.
Requirements
Licensure / Certification / Registration:
Education:
Work Experience:
Additional Preferences
#AscensionRx
Why Join Our Team
Ascension associates are key to our commitment of transforming healthcare and providing care to all, especially those most in need. Join us and help us drive impact through reimagining how we can deliver a people-centered healthcare experience and creating the solutions to do it. Explore career opportunities across our ministry locations and within our corporate headquarters.
Ascension is a leading non-profit, faith-based national health system made up of over 150,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.
Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.
Equal Employment Opportunity Employer
Ascension is an equal opportunity employer (EEO) and affords equal opportunity to all associates and applicants without regard to race, color, religion, national origin, citizenship, gender identity, sexual orientation, age, physical or mental disability, veteran status, genetic data, or other legally protected status.
For further information regarding your EEO rights, click on the following link to the “EEO is the Law” poster:
http://www.dol.gov/ofccp/regs/compliance/posters/pdf/eeopost.pdf
EEO is the Law Poster Supplement
Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.
Department: Pharmacy Administrative Support
Schedule: Full time, Monday - Friday, 8:30am - 5pm
Location: Remote
Benefits
Paid time off (PTO)
Various health insurance options & wellness plans
Retirement benefits including employer match plans
Long-term & short-term disability
Employee assistance programs (EAP)
Parental leave & adoption assistance
Tuition reimbursement
Ways to give back to your community
**Benefits can vary. Please note, your Talent Advisor can provide specifics to the role should you have questions.
Responsibilities
The Pharmacist Prior Authorization Specialist will retrieve, review and analyze pharmacy utilization and clinical appropriateness data based on plan criteria. Determine participation and coverage for pharmacy and medical plan.
- Participate in formulary committee meetings. Make recommendations to the committee regarding new medications, formulary placement of medications and prior authorization criteria as needed in conjunction with internal staff and plan(s).
- Post the Drug Formulary and prior authorization criteria.
- Assist members and providers with authorization denials in an effort to help them navigate towards a formulary treatment. Provide advisement with the authorization process.
- Review pharmacy prior authorization requests for medical necessity, using best practices and quality standards. Analyze medication claims data for potential Fraud Waste and Abuse (FWA), compliant claim adjudication, patient safety, and trends in drug cost. Supplies accurate, adequate and timely drug information.
- Analyze and interpret data to identify cost and clinical opportunities. Prepares statistical reports, and drafts presentations.
Requirements
Licensure / Certification / Registration:
Required Credential:
- Pharmacist obtained prior to hire date or job transfer date
Education:
Bachelor's degree in Pharmacy or Doctorate of Pharmacy required. Pharmacy residency preferred.
Work Experience:
None required.
Additional Preferences
- Pharmacy Benefit Manager (PBM) experience strongly preferred
- Participation in Pharmacy & Therapeutics Committee strongly preferred
- Project experience in growing and building criteria for new systems strongly preferred
- A willingness to learn new knowledge and skills
- 2 or more years of Managed Care/Health Plan Pharmacy experience
- 5 or more years of Hospital/Acute Care Pharmacy experience with P&T Committee involvement
#AscensionRx
Why Join Our Team
Ascension associates are key to our commitment of transforming healthcare and providing care to all, especially those most in need. Join us and help us drive impact through reimagining how we can deliver a people-centered healthcare experience and creating the solutions to do it. Explore career opportunities across our ministry locations and within our corporate headquarters.
Ascension is a leading non-profit, faith-based national health system made up of over 150,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.
Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.
Equal Employment Opportunity Employer
Ascension is an equal opportunity employer (EEO) and affords equal opportunity to all associates and applicants without regard to race, color, religion, national origin, citizenship, gender identity, sexual orientation, age, physical or mental disability, veteran status, genetic data, or other legally protected status.
For further information regarding your EEO rights, click on the following link to the “EEO is the Law” poster:
http://www.dol.gov/ofccp/regs/compliance/posters/pdf/eeopost.pdf
EEO is the Law Poster Supplement
Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.
This employer participates in the Electronic Employment Verification Program. Please click the E-Verify link below for more information.
E-Verify
E-Verify
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