Judi Health
Healthcare
AppealsPharmacist(temp-to-hire)
Neural analysis suggests this role is
optimal for Mid+ candidates.
“Appeals Pharmacist (temp-to-hire) at Judi Health. Skills: Pharmacist license, Appeals review, Clinical criteria interpretation. Evaluate and review all appeals requests. Render coverage determinations”
What You'll Achieve.
Meet client expectations regarding efficiency and quality; Meet established turnaround time requirements; Maintain quality and productivity standards
Industry & Context.
Clinical decision making
Designated secure workplace, Closed door office
What They're Looking For.
Must Have
Active, unrestricted, pharmacist license, 1+ years prior authorization review or appeals experience, Ability to work independently, Proficient in Microsoft Office Suite, Experience using clinical resources
Nice to Have
Experience working with Medicare appeals
What You'll Do.
Evaluate and review all appeals requests
Render coverage determinations
Perform and handle inbound and outbound phone calls
Facilitate appeal requests
Collaborate with Medical Directors
Provide appropriate clinical/medical data
Interpret clinical guideline criteria
Utilize clinical knowledge and resources
Render approvals and denials
Perform peer to peer reviews
Perform scientific literature evaluation
Support decision-making and recommendations
Provide detailed and thorough documentation
Make clinical prior authorization determinations
Maintain quality and productivity standards
Meet established turnaround time requirements
Remain current on all communications
Apply updated processes to daily responsibilities
Follow all internal Standard Operating Procedures
Adhere to HIPAA guidelines and policies
Deliver extraordinary customer care and service
Respond to questions concerning customer accounts
Adherence to Capital Rx Code of Conduct
How You'll Work.
Communication Scope
Oral communication; Written communication
Applying for this Appeals Pharmacist (temp-to-hire) role?
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