Prior Authorization & Appeals Pharmacist

Atrius Health, an innovative healthcare leader, delivers an effective system of connected care for more than 690,000 adult and pediatric patients at 30 medical practice locations in eastern Massachusetts. Atrius Health’s 645 physicians and primary care providers, along with 420 additional clinicians, work in close collaboration with hospital partners, community specialists and skilled nursing facilities. Our vision is to transform care to improve lives. Atrius Health provides high-quality, patient-centered, coordinated, cost effective care to every patient we serve. By establishing a solid foundation of shared decision making, understanding and trust with each of its patients, Atrius Health enhances their health and enriches their lives. Atrius Health is part of Optum, a health services company focused on building the leading value-based care system in the country.

SUMMARY

Atrius Health Specialty Pharmacy provides specialty pharmacy services to serve the complex medication needs of its chronic patients. Atrius Health Specialty Pharmacy provides a comprehensive service program that includes an on-site pharmacy staffed with a care team that includes Pharmacists and Pharmacy Technicians. Under general supervision of the Chief Pharmacist of Specialty (or Pharmacy Specialty Supervisor) and in accordance with Atrius Health policies and procedures, federal and state laws and regulations, and pharmacy professional standards, the Prior Authorization Pharmacist conducts clinical reviews of medical data collected to perform prior authorization requests for specialty medications. Responsible for all aspects include reviewing patient clinical information, writing clear and concise appeal letters to support therapeutics specific qualification to the patient case, and ongoing following up of all prior authorization needs. The Prior Authorization Pharmacist will apply clinical knowledge required for PBM approval criteria for prospective and concurrent reviews of cases.

EDUCATION/LICENSES/CERTIFICATIONS

Graduate of accredited school of Pharmacy; Pharm D or Bachelor of Science Degree in Pharmacy

required. Must currently be a Registered Pharmacist in the state of Massachusetts with an active pharmacist license without restrictions from the MA Board of Pharmacy. Must complete 20 Continuing Education (CE) credits per calendar year as required by Massachusetts Board of Pharmacy and in accordance with Pharmacy Staff License Monitoring and Maintenance of Credentials Policy. Must not be listed on the Exclusion Database List of Excluded Individuals and Entities (LEIE) maintained by the Department of Health and Human Services Office of Inspector General (OIG). Immunization certified required. American Heart Association Basic Life Support (BLS) required. Advanced Cardiac Life Support (ACLS) may be required based on specialty.

EXPERIENCE

Preferably 2+ years of hands-on pharmacy prior authorization and appeals experience

SKILLS

Excellent attention to detail and strong organizational skills are required. Must be team oriented and demonstrate excellent customer service skills, effective verbal and written communication skills, problem-solving abilities, and strong interpersonal skills when interacting with patients and colleagues. Strong computer skills are required. Proficient with Microsoft Office including Word, Excel, and Outlook. Must be proficient in Epic EMR platform and Pharmacy dispensing system.

Atrius Health is committed to a policy of non-discrimination and equal employment opportunity. All patients, employees, applicants, and other constituents of Atrius Health will be treated with respect and dignity regardless of race, national origin, gender, age, religion, disability, veteran status, marital/domestic partner status, parental status, sexual orientation and gender identity and/or expression, or other dimensions of diversity.

BENEFITS

• Up to 8% company retirement contribution
• Generous Paid Time Off
• 10 paid holidays
• Paid professional development
• Generous health and welfare benefit package