When the work you do every single day has a crucial impact on the lives of others, every effort, every detail, and every second matters.
This shared culture of passion and dedication pulses through Cedars-Sinai, and it’s just one of the many reasons we’ve achieved our six-consecutive Magnet designation for nursing excellence.
From working with a team of premier healthcare professionals to using state-of-the-art facilities, you’ll have everything you need to do something incredible—for yourself, and for others.
Join us, and discover why we are tied #1 in California and ten years in a row on the "Best Hospitals" Honor Roll.
This role is a remote position.
A staff member who works exclusively from home may be in California or one of the following approved states - Arizona, Nevada, Oregon, Colorado, Texas, Minnesota, Georgia and Florida.
Position does require employee to be onsite 1x a month for monthly regulatory inspection of medication storage.
The remote Clinical Prior Authorization Pharmacist Specialist at Cedars-Sinai Medical Center will work in collaboration with the Prior Authorization Pharmacy Technician, Drug Use Policy, as well as the authorizing providers to ensure safe, effective, and reasonable use of high cost-drug therapies.
Clinical Prior Authorization Pharmacists support timely patient treatment and optimize reimbursement for these medications.
The prior authorization staff support clinical prior authorizations for medical benefits, prevent denials, advocate for patients and assist in evaluation of payer (insurance) drug criteria.
Additional responsibilities include but are not limited to payor update reviews, claim data analysis, assist with appeal process, review and incorporate payor clinical criteria into medication use guideline.
The Prior Authorization Pharmacist also provides supports in navigating and obtaining payer coverage approval to facilitate discharge and/or prevent an admission.
The Pharmacist is responsible for clinical pharmacy services, including but not limited to identification of drug-related problems, identification of medication safety issues, review of medication orders for appropriateness and provision of in-services/drug information to the outpatient clinic sites of care and patients.
The Clinical Prior Authorization Pharmacist Specialist will also supervise the associated pharmacy technicians. #LI-RD1
Educational Requirements: Pharm.D. or equivalent degree from an accredited school of pharmacy. Licenses/Certifications: Current pharmacist licensure in the State of California. BLS certification as outlined in the Pharmacist Responsibilities in Cardiopulmonary Resuscitation(C.P.R.) What else are we looking for? Completion of a PGY1 residency or equivalent practice experience. Prior authorization experience is highly preferred. Possesses excellent clinical data base. Possesses experience in Medication Use Evaluation. Possesses excellent verbal and written communication skills. Possesses software skills e.g., Microsoft Office. Comprehensive knowledge of medical terminology as related to drug usage. Comprehensive knowledge of common disease states and pathologies. Ability to comprehend patient medical management plans. Ability to assess and apply current pharmacological and biopharmaceutical principles for the selection and use of drug products in a clinical setting. Ability to extract pertinent information from the patient or other sources and relate it to the patient care plan. Possess the verbal and written communication skills required to fulfill the pharmacist’s responsibilities. Ability to teach and serve as preceptor for training programs. Ability to prepare drugs needed for immediate administration. Ability to provide recommendations and monitor the use of drugs. Knowledge of laws, regulations and standards relative to pharmacy practice. Ability to adapt to change. Ability to prioritize workflow. Ability to evaluate medication regimens to meet the therapeutic needs of patients. Ability to learn and adapt to the use of automated information systems in daily practice. Demonstrated competency in techniques of pharmaceutical calculations, compounding and pharmacokinetics. Possess patient-centered communication skills. Possess computer skills necessary to perform job functions. Exceptions to be approved by the Chief Pharmacy Officer or designee.
