Medical Director Associate – CarelonRx
Core
Supports pharmacy prior authorization reviews to ensure turnaround time and compliance with Pharmacy Benefit Management regulatory requirements.
Role type
Licensed physician (MD/DO) utilization management specialist
Builds
Pharmacy benefit management services for members and providers
Domain
Healthcare / Pharmacy Benefit Management
Deliverable
client delivery
Required skills
Clinical guidance, peer-to-peer review with physicians, physician on-call rotation, regulatory compliance
Preferred skills
Utilization management experience
Technologies
CarelonRx clinical guidelines
Responsibilities
Provide clinical guidance for pharmacy prior authorizations, support clinicians for timely responses to members and providers, conduct peer-to-peer prior authorization reviews, participate in physician on-call weekend rotation
Seniority
Director Equivalent, hands-on IC
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