Must reside in California
Must have PharmD
Must have not restricted CA License
Remote
12 + months contract
SKills: Thorough knowledge of therapeutic use of outpatient medications
Previous experience in prior authorization review Microsoft Office (Outlook, Word, Copilot, etc.)
Prior experience with AuthAccel preferred.
• Support the clinical and operational implementation of P&T approved policies for the pharmacy benefit, for both the Commercial and Medicare lines of business
• Apply clinical expertise to PA reviews and work collaboratively with the PA and Call Center Teams to support access to safe, efficacious, and medically necessary medications
• Operate in compliance with all regulatory and accreditation requirements to ensure all requests are reviewed within regulatory required timeframes
• Serve as a resource to internal and external constituents regarding the Blue Shield drug formulary, medication policies and appropriate drug use
• Embrace BSC values by answering clinical and operational questions, participating in group discussions, and supporting other team members while working towards a collective goal
• Use clear and concise communications and on-brand messaging when communicating with providers or members
• Follow all corporate policies and procedures
• Operate in compliance with all regulatory and accreditation requirements, and corporate policies and procedures regarding the support access to safe, efficacious, and medically necessary medications