Job Description
Overview
At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.
Job Title
Physician Clinical Reviewer- Pediatric Neurology- REMOTE
Responsibilities
- Reviews cases in which clinical determinations cannot be made by the Initial Clinical Reviewer.
- Discusses determinations with requesting physicians or ordering providers, when available, within the regulatory time frame of the request by phone or fax.
- Provides clinical rationale for standard and expedited appeals.
- Provides assistance and acts as a resource to Initial Clinical Reviewers as needed to discuss cases and problems.
- Utilizes medical/clinical review guidelines and parameters to assure consistency in the physician review process so as to reflect appropriat...