PerformRx is a Pharmacy Benefits Manager (PBM) dedicated to clinical culture, boutique service and holistic solutions. Our mission is to help customers, doctors and patients use effective medication therapy to improve health and wellness. For more than 15 years, our focus has been on providing optimal service through a clinical culture which seeks to provide members with high quality care while ensuring our partners receive favorable costs. That culture is reflected in our employees; more than 80 percent of our staff members are Pharmacists and Pharmacy Technicians, and in the services we provide.

PerformRx is headquartered in Philadelphia. Our dedication to innovation and to providing the most efficacious outcomes is the core of our clinical culture and is the heart of PerformRx. PerformRx is a subsidiary of the AmeriHealth Caritas Family of Companies.

*** OPEN TO CANDIDATES NATIONWIDE ***

SUMMARY:

As a licensed healthcare professional employed in the Prior Authorization Department, your primary responsibility is to make determinations on prior authorization and requests for coverage of pharmaceutical products. Determinations include medical necessity and benefit decisions. Decisions are made in accordance with established pharmacy guidelines, contract criteria, industry regulations and sound clinical judgment. The Pharmacist II works independently with the support of supervisors and managers. The incumbent is a member of a team of peers committed to meeting or exceeding quality standards and customer performance guarantees.

Additional responsibilities include:

• Provide clinical support to the PerformRx Customer Care Center
• Engage Providers in discussions to support determinations
• Support Fraud and Abuse program system oversight
• Participate in various pharmacy-related projects
• Keep abreast of industry trends and regulatory changes
• Keep abreast of operational directives and customer reference materials

Pharmacist II will also assist supervisors in the following areas:

• Coordinate and monitor departmental staff activities
• Perform Prior Authorization queue management
• New customer implementations
• Customer Service Team representation
• New associate on-boarding and training
• Engage with external customers
• Communicate with other PerformRx operational areas for issue resolution and efficiency

Education/Experience:

• Bachelor’s degree required
• Active/current Pharmacist license required
• R.Ph.; Pharm. D. preferred
• Minimum two (2) years of current/recent pharmacy experience preferred
• Current/recent experience in managed care environment preferred