Are you an experienced Case Management with a desire to excel? If so, then Talent Software Services may have the job for you! Our client is seeking an experienced Case Management to work at their company in CA(Remote).

Primary Responsibilities/Accountabilities:

• Utilizing approved clinical coverage criteria to review prior authorization requests for clinical appropriateness and medical necessity within regulatory turnaround times.
• Collaborating with intake staff and pharmacy technicians to prepare cases before final review by a pharmacist.
• Send notifications regarding determinations to the provider and member.
• This position supports ongoing 2024-2025 business needs.

Qualifications:

• Knowledge of clinical pharmacology.
• Ability to interpret clinical charts and labs.
• Excellent oral and written communication skills.
• Proficiency with clinical compendia (Micromedex, Clinical Pharmacology, NCCN, AHFS, etc).

Preferred:

• Prior Authorization review experience.
• Experience with and/or knowledge of specialty and injectable medications.
• Completion of residency program.