Case Management 5

Day to Day Responsibilities
The day-to-day job responsibilities in this role include utilizing client's P&T approved clinical coverage criteria to review prior authorization requests for clinical appropriateness and medical necessity within regulatory turnaround times. Cases are prepared by our intake staff and pharmacy technicians before being sent to a pharmacist for final review. Notifications regarding determination are sent to the provider and member. This position supports ongoing 2024-2025 business needs.
Required Skills (top 3 non-negotiables):
1. Knowledge of clinical pharmacology. Ability to interpret clinical charts and labs.
2. Excellent oral and written communication skills.
3. Proficiency with clinical compendia (Micromedex, Clinical Pharmacology, NCCN, AHFS, etc).
Preferred Skills (nice to have)
1. Prior Authorization review experience.
2. Experience with and/or knowledge of specialty and injectable medications.
3. Completion of residency program.