Pharmacist

This is a fully remote position, open to applicants in Puerto Rico.

📋 Description

• Oversee outbound communications with healthcare providers.

• Offer assistance for both Medicare and Retirement through phone and chat channels.

• Assess clinical data submitted by providers to ascertain if a medication aligns with plan-specific coverage requirements.

• Analyze factors such as diagnosis, past therapies, treatment history, requested quantity, dosing, and clinical suitability.

• Approve requests that meet established criteria.

• Issue clinical denials when criteria are not fulfilled and when plan regulations permit pharmacist-level decision-making.

• Escalate cases to a Medical Director when regulatory or client stipulations necessitate a physician's review prior to issuing a denial.

• Record clinical justifications and ensure that all decisions are in accordance with client, state, federal, CMS, and accreditation standards.

⛳️ Requirements

• Current Pharmacist license.

• Minimum of 1 year of experience in a relevant field (e.g., office, administrative, clerical, customer service, etc.) utilizing phones and computers as primary tools.

• Proficient in advanced Microsoft and Windows PC applications, with the capability to navigate and adapt to new and complex computer systems.

• Availability to work 40 hours per week, Monday through Friday. Flexible to accommodate any of our 8-hour shift schedules during our regular business hours of 8:00 AM to 7:00 PM ATL.

• Bilingual proficiency in Spanish and English.

🏝️ Benefits

• Comprehensive health coverage options.

• Competitive salary package.

• Opportunities for professional development and advancement.

• Supportive and collaborative work environment.