Certified Pharmacist

EOR: One Workforce Global
Employment Type: Full-Time Employment
Work Setup: 100% Onsite (Office location in either Eastwood, Clark or Muntinlupa)
Work Schedule: Night Shift (Following U.S. Central Time Zone)

Duties and Responsibilities:

• Intake and triage PA requests from providers, pharmacy, and patients; confirm eligibility and benefits.
• Gather required clinical information (diagnosis, labs, previous therapies, step-therapy/QL/ST documentation).
• Prepare and submit PA requests via PBM/payer portals, eFax, or phone (e.g., CoverMyMeds, NaviNet, payer sites).
• Track cases to decision; proactively follow up on pending requests and expiring authorizations.
• Document all activities and outcomes in the EHR/pharmacy system and workflow tracker; maintain queue SLAs.
• Communicate decisions to patients and prescribers; coordinate next steps with dispensing/specialty pharmacy.
• For denials, collect missing info and prepare first-level appeals or redeterminations per policy.
• Maintain current knowledge of plan formularies, UM criteria, Medicare Part D, Medicaid, and commercial payer rules.
• Protect PHI and follow HIPAA, company policies, and quality standards
  

Job Requirements:

• Active RPH License is preferred.
• Prior Authorization experience for at least 4 years is required.
• Experience working in the pharmacy setting is a must.
• Versed in NextGen and Prior Authorization software (ex. CoverMyMeds) is a plus.
• Detail-oriented with strong organizational skills
• Ability to follow SOPs and meet deadlines
• Excellent verbal and written communication skills
• Excellent interpersonal and customer service skills
• Excellent organizational skills and attention to detail
• Excellent time management skills with a proven ability to meet deadlines
• Strong analytical and problem-solving skills
• Ability to prioritize tasks
• Ability to function well in a high-paced and at times stressful environment

WHY INTELASSIST?
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