Conduent Pharmacist - Prior Authorization in Elkridge, Maryland
Pharmacist - Prior Authorization
Conduent is the world's largest provider of diversified business process services with leading capabilities in transaction processing, automation, analytics and constituent experience. We work with both government and commercial customers in assisting them to deliver quality services to the people they serve.
We manage interactions with patients and the insured for a significant portion of the U.S. healthcare industry. We are the customer interface for large segments of the technology industry and the operational and processing partner of choice for public transportation systems around the world.
Whether it's digital payments, claims processing, benefit administration, automated tolling, customer care or distributed learning - Conduent manages and modernizes these interactions to create value for both our clients and their constituents. Learn more at www.conduent.com at https://conduent.taleo.net/enterprise/2015PRD.184.108.40.206.0/akira/pub/fckeditor/editor/www.conduent.com .
Responsible for managing Prior Authorizations for Maryland Medicaid claims for Opioid prescriptions using the client’s established clinical criteria and requirements, reviewing member profiles for signs of overutilization, duplication of therapy, multiple prescribers, and multiple pharmacies; answers calls from Physicians (prescribers) and Pharmacists/Pharmacy Technicians (providers) providing information on a variety of matters relating to the processing of prior authorizations; assists Certified Pharmacy Technician call center agents (internal staff) with prior authorization requests; uses the POS claims management system to enter appropriate information to support approving or denying claims based on the Medicaid program’s clinical rules.
Provides clinical medication therapy evaluations and recommendations to prescribers and providers regarding the safe, appropriate, and cost-effective use of medications.
Serves on internal committees and/or workgroups and completes special projects as assigned. Serves as a clinical resource and drug information specialist to medical, pharmacy, & nursing staff as well as to allied healthcare providers internally and externally.
At the direction of the Clinical Manager and/or the Director of the PBM project assists with:
Evaluating new drugs for clinical criteria and providing recommendations on coverage,
Recommending new and updated clinical criteria for prior authorizations, `
Providing ad-hoc query results to the client in support of clinical program recommendations using Business Objects, Cognos, and any other Client reporting tools.
Attends and contributes to the Conduent Clinical Services weekly meeting and the Account Clinical Meeting.
Participates in efforts to improve performance measures.
Contributes to the improvement of processes, systems, tools, procedures
Candidate Education: Bachelor's Degree/PharmD in Pharmacy
Registered Pharmacist with the State of Maryland Board of Pharmacy in good standing.
Prior authorization experience with Opioids/Substance Use Disorder medications and/or advanced certification in Pain Management/Substance Abuse.
The ideal candidate will have completed a specialized residency program (e.g. pain management, substance abuse, drug information, pharmacotherapy, etc.) or postgraduate training.
Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form at https://downloads.conduent.com/content/usa/en/file/conduent-applicant-adaaa-referral-form.pdf .
Job Client Services
Primary Location United States-Maryland-Elkridge
Unposting Date Ongoing
Req ID: 18009793