Pharmacist Operations Advisor - Apidel Technologies

This is a RAMP order 12/2 start

Safety Sensitive Role

Must provide a copy Registered Pharmacist License with Resume in state of residence
include state & time zone on resume
Include a screenshot of license and internet speed

As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. You will be responsible for ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to providers for more information when needed, and ensuring accurate decisions that comply with compendia and Medicare guidance and timelines. This is a great opportunity to initiate a career with a leading healthcare company by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience.

1. Attendance is extremely important, especially during the initial 8 weeks of training. The new hire must be available M-F from 9am-5:30pm EST for the first 8 weeks (no vacation time planned). All time off needed should be discussed and disclosed during this initial review.
Do you have any conflicts with the training schedule or time off planned during assignment duration

2. After training, our hours of operation are 8-8 EST/CST M-F with a weekend schedule. Do you have any conflicts working an assigned 8-hour shift between 8AM 8PM EST/CST with a weekend schedule

3. This is a work from home (WFH) position; must have a dedicated quiet, separate space in which to work with wired internet meeting 25mbps min download and 5mbps minimum upload speed. Previous WFH experience is preferred.
Do you have a separate workspace with no interruptions
Please include a copy of internet speed at the top of resume

4. Must be able to sit and focus on work for the duration of shift.
Are you able to sit and focus with no interruptions for entire shift

5. Data entry and navigating multiple computer applications while utilizing two screens is the primary function of job (possible outbound calls needed). A job history demonstrating this is recommended.
Do you have data entry experience

6. Active Pharmacist license is required in the state you live in.
provide a copy of license with expiration date on resume

7. Successfully worked independently in a data entry, productivity driven role is preferred.
Are you able to work independently

8. As a company we strive for a team that is engaged and positive so candidates that demonstrate this would be ideal. Do you feel you have the engagement and positive attitude to work this assignment

Duties
Ensure accuracy of case setup and clinical review of Medicare appeals cases. Review internal notes or fax requests thoroughly for pertinent information. Provide clear, concise, and accurate documentation for case reviews. Contacting providers, if needed, for clinical information to decision cases. Utilize work instructions and Medicare guidelines for accurate case processing. Comply with CMS mandated timelines and department productivity and quality standards. Acquire and utilize clinical judgement and knowledge, drug compendia resources, relevant and changing work instructions, and CMS Medicare guidance. Participate in development discussions receiving feedback from direct supervisor.

Experience
1. Active pharmacist license in the state of residence that is in good standing
2. Ability to utilize multiple software systems, simultaneously with a 2-screen workstation setup (Windows based operations, AS400, MHK, PeopleSafe, WI database, Microsoft office applications)
3. Ability to type 30 WPM or greater
4. Excellent oral and written communication skills
5. Ability to multi-task, prioritize, and manage time effectively in a fast-paced, highly regulated environment
6. Must be able to review large volume of information, determine importance, and apply clinical knowledge to assist in outcome
7. Must be able to work independently and utilize critical thinking/problem solving skills to make case decisions
8. Receptive to constructive feedback and flexible in adapting to change
9. Flexibility with working a rotating schedule including overtime, weekends, and holidays
10. Previous experience in Managed Care/PBM environment (preferred)

Position Summary
As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. You will be responsible for ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to providers for more information when needed, and ensuring accurate decisions that comply with compendia and Medicare guidance and timelines. This is a great opportunity to initiate a career with a leading healthcare company by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience.

Education
High School Diploma or GED required. Bachelor\'s degree in pharmacy or Pharm D. also required with at least two years experience as a pharmacist. Must have an active license in good standing.

What days & hours will the person work in this position List training hours, if different.
Training hours M-F 9a-5:30p EST. After training 8hr Shift M-F with a weekend schedule.