United States onlyPutting People First in Pharmacy- Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other.
We are unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.
The Pharmacist II, Clinical Prior Authorization will be responsible for: performing Prior Authorizations; perform duties related to Drug Utilization Review including concurrent, retrospective, and prospective components; and support Customer Care with clinical calls requiring pharmacist intervention.
The Pharmacist II, Clinical Prior Authorization is also responsible for interfacing with physicians, pharmacists, and specialty pharmacy providers with respect to beneficiaries’ benefits and therapeutic interventions and reviewing/evaluating the health surveys and utilization data for program management and development.
The Pharmacist II, Clinical Prior Authorization will coordinate with Clinical Account Executives and Program Managers to enhance their support and understanding of related Pharmacy Benefit Management (PBM) programs. Additionally, the Pharmacist II, Clinical Prior Authorization will develop and maintain appropriate clinical, evidence-based documentation that supports PBM programs. The primary functions involve ensuring that Navitus can provide clinically sound programs and medications in the most cost-effective manner and utilize technology to implement on-line PBM programs. The Pharmacist II, Clinical Prior Authorization is responsible for providing information as it relates to Navitus clinical goals and is a primary resource regarding all clinical pharmacy questions.
Is this you? Find out more below!
How do I make an impact on my team?
- Responsible for support and input to clinical programs such as: Health Management, Drug Utilization Review, Formulary development, and Prior Authorization programs to encourage appropriate, high-quality, cost-effective drug therapy, and to identify opportunities for improvement in efficiency, accuracy, and appropriateness of the programs in place.
- Participate in the Coverage Determination (Certification, Prior Authorization, Medical Exception, Exception to Coverage, etc.) process be reviewing all requests which are not clearly approvable based on specified criteria (algorithms), making all coverage denial determinations, and identifying themselves by first name, title, and responsibility at Navitus in relation to drug utilization management program administration
- Continually monitor the quality and efficiency of the Coverage Determination process including coverage criteria, denial language, and communication with prescribers.
- Provide input to clinical content of new programs and for maintenance of existing programs.
- Complete all annual URAC training requirements
- Responsible for participating in core teams working on new program/ product development.
- Facilitation of communication and education to clients, members, and internal staff regarding clinical daily issues and objectives.
- Provide support to operational departments on the implementation of various PBM programs and daily functioning in support of member/patient quality of care.
- Responsible for supporting / providing clinical expertise related to formulary decisions made by the Pharmacy and Therapeutics committee.
- May review health care survey data for Medicare Part D qualified participants and/or perform phone consultations with Med-D enrollees; aid in documentation of calls; designate enrollees for repeat interaction.
What our team expects from you?
- A minimum of a bachelor’s degree in pharmacy or Pharm D. Current unrestricted licensure as an RPh in the State of the home office of the pharmacist, or the ability to gain reciprocity within 4 months of employment is required.
- Minimum two years clinical experience, or clinical or managed care pharmacy practice residency, and at least 1 year experience as a Navitus Clinical Operations pharmacist, Clinical Staff pharmacist or in a comparable role.
- Knowledge of PBM industry, formulary management, pharmacy claims and managed care principles and practices desired.
- Exceptional clinical skills and ability to apply sound clinical judgment to a variety of situations is necessary.
- Proficiency in drug literature and clinical trial evaluation, including proficiency with electronic databases (e.g., Micromedex, Medline, Internet) preferred.
- Ability to reason and translate clinical information into a manner appropriate for clinical systems and clinical/non-clinical audiences.
- Emphasis on problem-solving skills, including identifying and accepting a challenging situation and creating and implementing a solution.
- Requires attention to details to assure projects are clinically, editorially, and systems accurate and can be operationalized.
- Proficiency in MS Word, Excel, Power Point including tables, charts and figures preferred.
- Participate in, adhere to, and support compliance program objectives
- The ability to consistently interact cooperatively and respectfully with other employees
What can you expect from Navitus?
- Hours/Location: Monday-Friday 8:00am-6:00pm, CST-Remote
- Paid Volunteer Hours
- Educational Assistance Plan and Professional Membership assistance
- Referral Bonus Program – up to $750!
- Top of the industry benefits for Health, Dental, and Vision insurance, Flexible Spending Account, Paid Time Off, Nine paid holidays, 401K, Short-term and Long-term disability, College Savings Plan, Paid Parental Leave, Adoption Assistance Program, and Employee Assistance Program
