We help patients get the medication they need by reviewing rejected pharmacy claims and doing as much as possible to get them approved for the patient. This group focuses on Medicaid patient's and specific criteria questions that coordinate with this plan. This process is very similar to the Medicare Part D group, but the system/platform is different. Work can be described as using more clinical judgment then others.
-Responsible for the clinical evaluation for step therapy, prior authorization, quantity limit, and formulary exception requests. This includes consideration of the denial language and appropriateness of the decision as it pertains to the clinical content of the case and the intent of the individual client's pre-approved criteria.
-Accountable for direct consultation with health care providers concerning non-formulary and clinical product coverage issues.
-Responsible for developing clinical criteria under the oversight of the UM clinical department infrastructure.
-Development and maintenance of clinical support documents for staff.
-Training staff on new or revised clinical criteria.
Pharmacist will be responsible for following very specific criteria to determine if pharmacy Prior Authorizations should be approved or denied. They are responsible for documenting denial reasons. They are responsible for reviewing so many claims a day. They get trained in specific drug classes.
Our people are everything. As a Best of Staffing® Client and Talent leader, Aerotek® Inc. has distinguished itself as a leader in recruiting and staffing services, by having a deep understanding of the intersection of talent and business. As a strategic partner to more than 17,000 clients and 300,000 contract employees every year, Aerotek's people-focused approach yields competitive advantages for its clients and rewarding careers for its contract employees. Headquartered in Hanover, Md., Aerotek operates a network of over 230 non-franchised offices with more than 6,000 internal employees dedicated to serving our customers. Aerotek is an operating company of Allegis Group, a global talent solutions provider. To learn more, visit aerotek.com.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please call 888-237-6835 or email accommodation@aerotek .com for other accommodation options. However, if you have questions about this position, please contact the Recruiter located at the bottom of the job posting. The Recruiter is the sole point of contact for questions about this position.