Pharmacist

Apex Systems LLC, a division of On Assignment, is an IT staffing and services firm specializing in providing IT professionals for contract, contract-to-hire, and direct placements. Apex also offers recruitment solutions for other select professional skills and workforce needs

Position Summary: Responsible for reviewing clinical coverage determination and appeals using Medicare and client specific requirements. Knowledgeable in all aspects of coverage determination and appeals process and assist in meeting clients expectations regarding efficiency, services levels, privacy maintenance and quality decision making. Work as part of the team to meet business unit objectives. The Pharmacist will be responsible for reviewing medication exception request, as well as completing data analysis and various clinical projects. Escalate issues to Coverage Determinations and Appeals management team as needed. Position will require schedule flexibility including rotations through nights, weekend and holiday coverage. All other duties are required to meet business needs.

Duties: Responsibilities :

1. Review the information provided upon request by utilizing the designated tools (web based) for further research. High proficiency in computer skills is necessary including but not limited to Microsoft Word, Microsoft Excel, and web based programs. 60% 

2. Outreach for additional information. May include Pharmacy, Prescribers, Members, etc. as appropriate 25% 

3. Data Entry (Electronic Database) recording decision making, inputting clinical notation, request for additional information, faxes, summary, etc. 10% 

4. Training - attending meetings, online job aides, process changes, new initiatives, communication, etc. both formal and informal training 5%

Experience: REQUIRED SKILLS: 

1. Self-motivated with a strong attention to detail 

2. Excellent verbal and written communication and interpersonal skills w/ ability to maintain patient confidentiality 

3. Strong clinical decision making skills 

4. Customer Service internally and externally 

5. Proficient computer skills and the ability to navigate in a Windows based environment 

6. Ability to follow directions, and adapt in dynamic work environment; ability to adapt to change and remain flexible 

7. Adaption to Change Management 

8. Ability to work in a high pressure, time sensitive environment 

9. Project a professional business image, through phone interaction as well as internal communications 10. Demonstrates resourcefulness in problem-solving 

11. Demonstrates a sense of urgency with assignments 

12. Strong organizational skills 

13. Able to prioritize and manage multiple tasks 

14. Ability to read, analyze and interpret general business correspondence, technical procedures and governmental regulations. 

15. Ability to identify and solve practical problems and deal with a variety of concrete variables in standardized situations. Ability to perform basic mathematic calculations maybe required 

16. Ability to interpret a variety of work instructions provided through a variety of mediums 

17. Ability to consistently meet quality and production standards 

18. Displays confidence in the ability to learn complex material 

19. Demonstrates intellectual curiosity through inquiries to ensure deep understanding of the business and deliver accurate results 2 years experience required, 2-5 years experience preferred.