- CVS Health (Columbus, OH)
- …AND RESPONSIBILITIES: 1. Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design ... * Board Certified Oncology Pharmacist (BCOP) required * 2+ years clinical pharmacist experience, inclusive of prior authorization experience * Knowledge of… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- … in addition to being responsible for the daily Clinical Pharmacist operations and decision-making process related to coverage determinations , ... for all aspects of Formulary maintenance and management. The Clinical Pharmacist may also be required to...Therapeutics Committee Meeting + CMS Model Letter Reviews + Coverage Determinations and monitoring of optimal cost… more
- CVS Health (Columbus, OH)
- …Responsibilities: 1.) Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan ... And we do it all with heart, each and every day. **Position Summary:** The Clinical Pharmacist is an operation-based role that conducts criteria based & … more
- US Tech Solutions (May, OK)
- …**Job Description:** + Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design. ... Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and… more
- Molina Healthcare (Vancouver, WA)
- …**KNOWLEDGE/SKILLS/ABILITIES** The Pharmacist , UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate ... requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services (such as, therapeutic drug monitoring, drug...manner. The Pharmacist , UM will also be responsible for serving as… more
- Corewell Health (Grand Rapids, MI)
- …medication distribution process in the managed care setting. Essential Functions + Uses clinical expertise to make coverage determinations and ensure ... is a one year period of transition from general residency trained pharmacist to clinical pharmacist with a specific area of expertise. The residency… more
- Sharp HealthCare (San Diego, CA)
- …**Preferred Qualifications** + 2 Years Pharmacy experience in a related clinical area. + Certified Pharmacy Technician (CPhT) - Pharmacy Technician Certification ... + Utilizes reliable transportation and possesses adequate personal insurance coverage . Demonstrates clean driving record in accordance with requirements of… more
- US Tech Solutions (May, OK)
- …required to initiate and/or resolve coverage requests. Escalate issues to Coverage Determinations and Appeals Learning Advocates and management team as ... clinical questions, escalations and judgement calls to the pharmacist team. The Rep I, Clinical Services...to requesting providers to obtain additional information to process coverage requests and complete all necessary actions to close… more
- US Tech Solutions (RI)
- …to initiate and/or resolve coverage requests. + Escalate issues to Coverage Determinations and Appeals Learning Advocates and management team as needed. ... clinical questions, escalations and judgement calls to the pharmacist team. + The Rep I, Clinical ...to requesting providers to obtain additional information to process coverage requests and complete all necessary actions to close… more
- US Tech Solutions (May, OK)
- …to initiate and/or resolve coverage requests. + Escalate issues to Coverage Determinations and Appeals Learning Advocates and management team as needed. ... Transfers all clinical questions, escalations and judgement calls to the pharmacist team. **Responsibilities:** + The Rep I, Clinical Services will also… more
- Veterans Affairs, Veterans Health Administration (Salt Lake City, UT)
- …Establishes work schedules and allocates staff as needed to provide adequate coverage . Maintains time and attendance records and approves leave. Assesses workload ... (ie, Puerto Rico), or the District of Columbia. The pharmacist must maintain current registration if this is a...as required by 38 USC 7402(d), and 7407(d). Grade Determinations : GS-13 Experience. In addition to the GS-12 requirements,… more