Job Description
***FULLY REMOTE OPPORTUNTY***
MUST HAVES:
Job Overview: This team reviews medication prior authorization requests and coverage determinations for the Medicaid, Medicare and Health Exchange lines of business. Your position's main purpose is to define and develop standard and custom formulas for assigned plans. A typical day consists of reviewing 140 to 160 clinical prior authorizations or coverage determinations.
Develop clinical criteria for medications, recommend plan design changes, and clinical programs to be initiated
Monitor prior authorization requests
Provide clinical support to internal departments and address clinical related questions
Ensure appropriate quality controls and initiates opportunities for performance improvement in pharmacy/practice
Develop and implement programs designed to impact DUR for both Medicaid and Medicare
Develop, implement, and maintain policies and procedures for the pharmacy department
Participate in the coordination of the Medicare MTM program
Assist case management team with members including clinical rounds presentations
Necessary Experience Needed:
Company Description
Media Riders Inc is a family-owned Recruitment and Staffing Services company. Providing recruitment and payroll services to our customers, who directly support State and/or Federal funded programs. We are an SBA certified Women-Owned Small Business (WOSB) and Texas certified Historically Underutilized Business (TxHub).
Media Riders Inc is a family-owned Recruitment and Staffing Services company. Providing recruitment and payroll services to our customers, who directly support State and/or Federal funded programs. We are an SBA certified Women-Owned Small Business (WOSB) and Texas certified Historically Underutilized Business (TxHub).
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