Pharmacy Utilization SpecialistPosted: November 7, 2009
We are currently sourcing for a position with our DIRECT client and would like to discuss this opportunity with you.
Established in 1995, Rangam Consultants is a multiple service provider in the Information Technology, Scientific, Engineering and administrative fields. We have a proven track record for successfully delivering mission critical consulting, support and recruiting services to various government and Fortune 500 clients.
The details for this position are as follows:
Job Title: Pharmacy Utilization Specialist
Job Code: RCI-HOR-1521-1
Job location:- 210 Silvia Street, West Trenton, NJ 08628
Duration: 4 Months
Start Date: ASAP
JOB DESCRIPTION:
1. Process prior authorizations received via prior authorization help line, by evaluating the medical necessity/appropriateness for specific drugs and based on medical criteria.
2. Directly interact with members physician office staff, pharmacies and internal stake holders for eligibility, coverage determination claims issues.
3. Conduct intervention with physician & pharmacy office staff to facilitate formulary compliance and generic dispensing.
4. Process appeals complaints executive inquiries and compliance related issues.
5. Provide recommendations to increase efficiency, accuracy and productivity in the department.
6. Process ad hoc request for information or reports from stakeholders.
7. Participate in client member and employee training to ensure practical understanding of pharmacy services programs and operations
Knowledge:
Requires knowledge of popular brand and generic drug names.
Requires knowledge of third party prescription program claim adjudication.
Requires working knowledge of managed care principles.
Requires knowledge of common medical terminology.
Requires understanding of National Drug Code (NDC).
Requires knowledge of State of New Jersey Board of Pharmacy regulations and State Federal controlled substances regulation.
Skills and Abilities:
• Requires the ability to utilize a personal computer and applicable software.
• Must have effective verbal and written communication skills and demonstrate the ability to work well within a team. Demonstrated ability to deliver highly technical information to less technical individuals.
• Must demonstrate professional and ethical business practices, adherence to company standards, and a commitment to personal and professional development.
• Proven time management skills are necessary. Must demonstrate the ability to manage multiple priorities [or tasks], deliver timely and accurate work products with a customer service focus, and respond with a sense of urgency as required. Demonstrated ability to work in a production focused environment.
• Proven ability to exercise sound judgment and strong problem solving skills.
• Proven ability to ask probing questions and obtain thorough and relevant information.
If interested:
Please provide us the following information:
1) Hourly rate on W2 or expected salary _________
2) Resume in Word format __________
3) Contact information, where we can reach you _________
4) Three professional references with their Name, Company Name, Title and Phone # ________
5) Are you authorized to work for any employer? __________
6) Date of Birth (Only Month and Date for use as a unique identifier. We DO NOT need the year. You may provide this over the phone)
I look forward to hear from you.
Best regards,
Seema Singh
Rangam Consultants Inc.
Somerset NJ 08873
Direct No:- 908 450 9299 Ext - 312
Alt Phone No: 908 704 8843
Fax: 908 253 6550
Email: staffing@rangam.com
Alt e-mail id: rangamconsultantsinc@gmail.com
WWW.RANGAM.COM
FOR ALL CURRENT OPEN JOBS @ RANGAM CLICK HERE
Message Id : #ID# Please refer to job code RCI-HOR-1521-1 when responding to this ad.
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