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Clinical Pharmacy Review Specialist at Presbyterian Healthcare Services - ApplyBlast

Clinical Pharmacy Review Specialist

Presbyterian Healthcare Services

20 hours ago

3.6 on Glassdoor

Remote

Full Time

Junior

0 applicants

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About this role

The Clinical Pharmacy Review Specialist provides clinical support for the Pharmacy Services Department by reviewing and evaluating prior authorization requests, coverage determinations, and appeals. This role involves researching clinical data, communicating with members and providers regarding benefit coverage, and assisting clinical pharmacists with medication therapy management. The position requires strong critical thinking skills and knowledge of pharmacy laws, regulations, and managed care principles.

Responsibilities

Review prior authorization requests for appropriateness and medical necessity
Prepare clinical data for coverage determinations and appeals
Analyze rejected pharmacy claims and identify resolution strategies

Skills

Qualifications

Certified Pharmacy Technician-PTCB

About Presbyterian Healthcare Services

phs.org

Headquarters

Albuquerque, New Mexico, United States

Company Size

10001+ employees

Founded

1908

View Profile

Find the medical care and health plan you and your family need at Presbyterian Healthcare Services, an integrated system of hospitals, healthcare providers and insurance plans serving patients and members in New Mexico.