Prior Authorization Nurse
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Job Location:
Smyrna, GA - USA
Monthly Salary:
Not Disclosed
Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
JOIN A LEADING HEALTHCARE COMPANY
Do you want to join a leading healthcare team focused on nurturing long-term patient and caregiver relationships Do you want to be a part of a company that is committed to hiring the best people and using the best technology and tools to deliver improved health outcomes for patients and partners If so take a look at the available career opportunities at Curant Health.
Curant Health is searching for a Prior Authorization Pharmacist to join its team in Smyrna GA. The Prior Authorization Pharmacist oversees clinical and operational aspects of specialty medication prior authorizations. This role involves processing and evaluating PA requests supervising PA specialists and serving as a clinical resource to both internal and external stakeholders.
Key Responsibilities:
- Perform duties primarily related to specialty medication prior authorization
- requests (i.e. biopharmaceuticals) according to established treatment protocols
clinical criteria and member benefits. - Define and coordinate specialty medication prior authorization and drug utilization
review reports for clients and ensure regulatory reporting requirements for drug
utilization review fraud and abuse reporting are met. - Interface 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. - Support Customer Care with clinical calls requiring nurse intervention for
medication-related prior authorizations. - Review initial PA requests according to published policies and procedures
applicable clinical criteria and regulatory and compliance requirements. - Process PA appeals including first level reviews and coordinate second level
appeals cases for review by the designated Appeals Vendor as required. - Serve as clinical and PA operational resource to internal and external
customers/clients as required. - Continually monitor the quality and efficiency of the Coverage Determination
process including coverage criteria denial language and communication with
prescribers. - Responsible for staying current with clinical literature and guidelines and relaying
those to the program development core teams. - Have general understanding of and perform in compliance with the current
Specialty Pharmacy URAC standards applicable to the position. - Perform other duties and responsibilities as assigned.
Why Work for Us
We offer competitive pay paid holidays benefits paid time off and a work/life balance. Not only that but we also offer paid parental leave recognition programs promotion opportunities a comprehensive training program to enhance your career and employee prescription discounts.
Required Experience:
IC
