Navitus Health Solutions is seeking a Clinical Grievance and Appeals Pharmacist to join our Grievance & Appeals department!
The Clinical Grievance and Appeals Pharmacist will be responsible for performing Appeals and Redeterminations, Grievance Quality of Care reviews, perform duties related to Drug Utilization Review including concurrent, retrospective, and prospective components, and serve as a liaison and clinical support the Grievance and Appeals staff for clinical calls requiring pharmacist intervention. The Clinical Grievance and Appeals Pharmacist is also responsible for interfacing with physicians, pharmacists, and specialty pharmacy providers with respect to beneficiaries’ benefits and therapeutic interventions. Additional responsibilities include reviewing/evaluating the health surveys and utilizing data for program management and development. The Clinical Grievance and Appeals Pharmacist will coordinate with Clinical Account Executives and Program Managers to enhance their support and understanding of related Pharmacy Benefit Management (PBM) programs. Additionally, the Clinical Grievance and Appeals Pharmacist will develop and maintain appropriate clinical, evidence-based documentation that supports PBM programs. The primary functions involve ensuring that Navitus can provide clinically sound programs and medications in the most cost-effective manner and utilize technology to implement on-line PBM programs.
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We are unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.
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