Job Description
• Track and triage coverage determination requests submitted from providers and determine if a pharmacist review is required
• Obtain verbal authorizations and request detailed clinical information from prescribers
• Approve coverage determination requests based on defined criteria
• Enter and document coverage determination request decision into the PBM system and notify providers and/or members
• Respond to client inquiries regarding authorization approvals and PBM on-line applications
• Refer coverage determination requests for specialty drugs to delegated vendor or client for processing
• Contact providers for additional information to facilitate coverage determination reviews
• Notify physicians, providers and members of coverage determination request decisions
Hard SkillsReviewing prior authorization requestsMaking coverage decisions based on plan criteriaDocumenting decisions in PBM systemObtaining verbal authorizationsRequesting clinical information from prescribersJob Type
This is a contract position with a duration of 3 Month(s).
Work Site
This is a fully remote position.
Work Environment
This position will be fully remote. Candidate will work remote and can be nationally sourced but needs to be available during the above shift time.
Benefits
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
Medical, dental & vision
Critical Illness, Accident, and Hospital
401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
Life Insurance (Voluntary Life & AD&D for the employee and dependents)
Short and long-term disability
Health Spending Account (HSA)
Transportation benefits
Employee Assistance Program
“Posting close date October 14, 2024.”
About ActalentActalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
Diversity, Equity & InclusionAt Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
Hiring diverse talent Maintaining an inclusive environment through persistent self-reflection Building a culture of care, engagement, and recognition with clear outcomes Ensuring growth opportunities for our peopleThe company is an equal opportunity employer and will consider all applications without regard 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 email actalentaccommodation@actalentservices.com for other accommodation options.