Medication Access Specialist – Community Pharmacy

Job not on LinkedIn

🔥 12 hours ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

👫 Community Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 20%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Open for 1 day.
• Jobs at this company usually fill in 41 days.
• No salary listed.

Apply Now

Check your resume score

Customize resume + cover letter

Find Similar Remote Jobs

☆ Save☑️ Mark as applied❌ Hide

Report problem

University of Miami

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1925

🏥 Healthcare

📚 Education

💰 $1M Grant on 2023-02

Healthcare • Education

University of Miami is a prestigious private research university located in Coral Gables, Florida. It offers a wide range of undergraduate, graduate, and professional degree programs through its numerous schools and colleges, including the School of Architecture, College of Arts and Sciences, and Miami Herbert Business School among others. The university is recognized for its contributions to research, particularly in areas such as marine and atmospheric science through the Rosenstiel School, as well as in medicine through the Miller School of Medicine. The institution is also noted for its vibrant student life, with a strong emphasis on athletics and community engagement. University of Miami is committed to fostering an inclusive educational environment and is home to a diverse student body from around the globe.

📋 Description

• Review medical necessity documentation, clinical criteria, and therapy appropriateness for complex or high-cost prior authorization and appeal requests • Serve as clinical reviewer of record for peer-to-peer reviews and complex appeals • Present clinical rationale to prescribers and payer medical directors • Draft and review letters of medical necessity with prescribers and clinical pharmacy and nursing teams • Recommend clinically appropriate alternative therapies when initial requests are denied • Provide clinical rationale for site-of-care determinations • Support cell and gene therapy access, including bridging therapy options and coordination of CRS monitoring logistics • Provide case consultation to MAC I to IV coordinators on denials, coverage criteria, and unusual clinical circumstances • Support coordinator training and competency development • Conduct retrospective reviews of payment denials and underpayments • Identify trends and recommend process, policy, and contract improvements • Maintain current knowledge of payer prior authorization criteria, step therapy, and formulary policies • Provide clinical input to P&T and related workgroups • Document clinical interventions, recommendations, and outcomes for quality reporting and program metrics • Report to the Manager, Medication Access • Partner with prescribers, payer medical directors, and the coordinator team to resolve complex coverage determinations

🎯 Requirements

• Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy (BS Pharmacy), or Bachelor of Science in Nursing (BSN) or higher nursing degree • Active, unrestricted Florida license in good standing as a Pharmacist (RPh) or Registered Nurse (RN) required • Pharmacist pathway: board certification preferred (for example, BCPS or BCOP) or Certified Specialty Pharmacist (CSP) • RN pathway: Certified Case Manager (CCM), Oncology Certified Nurse (OCN), or Certified Registered Nurse Infusion (CRNI) preferred • Two to four years of pharmacist or registered nurse experience required • Specialty pharmacy, oncology or infusion nursing, prior authorization and appeals, case management, or medication access experience preferred • Working knowledge of payer prior authorization and appeals processes, medical necessity criteria, and specialty and high-cost drug policy • Clinical knowledge of specialty, oncology, infusion, and cell and gene therapies • Familiarity with infusion and site-of-care programs, REMS requirements, and manufacturer hub and patient support programs preferred • Strong written and verbal communication for peer-to-peer reviews, appeals, and coordinator consultation • Ability to work within the scope of the incumbent's license (RPh or RN) and escalate questions outside that scope to the appropriate licensed colleague • Ability to analyze denial and reimbursement data and translate trends into recommendations • Ability to work independently in a remote setting; working knowledge of HIPAA and confidentiality requirements • Clear written and oral communication in English

🏖️ Benefits

• Comprehensive benefits package including medical and dental coverage • Tuition remission • Competitive salary

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume