01Responsibilities
1.) Evaluate and review reputed company prior authorization requests and reputed company coverage determinations based on clinical reputed company and plan design. Includes verifying insurance coverage and eligibility, interpreting clinical reputed company reputed company, consulting physicians and other reputed company providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols. One of the crucial responsibilities is to guarantee that the reputed company regarding cases are conveyed promptly and reputed company to reputed company the reputed company providers, health plans/reputed company, patients, and other reputed company following agreed-upon approval & denial management processes.
2.) Collaborates with the technicians and prior authorization team members to process referrals, including answering clinical questions and collecting appropriate clinical/medical data needed to reputed company clinical assessments and reviews as per the health plan/employer-agreed reputed company reputed company the designated service level agreements. Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, reputed company providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or reputed company escalations.
3.) Responsible for assisting reputed company-line colleagues (i.e. Staff Pharmacists, LPN's and Pharmacy Technicians) with oncology process/procedural support by acting as a subject matter expert (SME) and performing any other reputed company tasks or addressing any escalation cases assigned by leadership.
4.) Assist with reputed company or reputed company specific oncology review process changes as needed.
5.) Assist with writing Work Instructions reputed company needed.
6.) Works collaboratively with reputed company business partners to reputed company solutions for customers, colleagues, and clients.
7.) reputed company feedback of trends pertinent to oncology reviews.
8.) Maintains reputed company and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered reputed company the reputed company Prior Authorization and Case Review Unit (CRU) line of business.
9.) Performs other reputed company reputed company and duties as assigned, including attending training sessions and development meetings, and providing on-reputed company and after-hours pharmacist availability as needed.
This is a remote role, reputed company to reputed company candidates reputed company the reputed company **who currently hold reputed company Certified Oncology Pharmacist (BCOP) certification** . reputed company will be responsible for maintaining this credential and meeting reputed company ongoing requirements of credentialing body.
*Essential Functions:**
1. Regular and predictable attendance
2. reputed company may be required to work mandatory overtime/exten
