Prior Authorization Pharmacist

DescriptionSXC Health Solutions, Inc. (SXC) is a leading provider of pharmacy dispensing and benefits processing solutions to the pharmaceutical benefits industry. We are looking for a Prior Authorization-Pharmacist to join their growing company in Lisle, IL. SXC's comprehensive suite of service offerings and software-based solutions support a wide array of organizations across the full spectrum of the pharmacy supply and delivery system. For more information go to www.SXC.com

Responsible for the development and implementation of public sector PA programs in addition to any other clients taking PA services, providing daily operational support to the Prior Authorization (PA) department, and serving as a PA resource for both internal and external SXC customers.

Essential Job Functions:
oServe as a clinical resource to the PA staff in reviewing denied, unclear or questionable PA requests. Communicate PA/appeal requirements to healthcare providers as requested.
oAssist the PA manager in the daily operations of the PA department including the planning and implementation of new client PA programs.Educate PA staff on client or SXC specific PA guidelines
oDevelop new product PA guidelines as required and administer client PA appeal services including first level appeal reviews and coordination of 2nd level appeals with the appeal vendor.
oHandle any escalated calls and other issues that may arise on the floor to help maintain a smooth workflow and ensure turnaround times/SLAs are met for each client.
oAssist in recruitment and training activities for internal/external candidates entering the clinical operations department
oOther activities as determined by the PA Manager
oMay include Supervisory duties such as managing a small team of reps, assist in recruitment and training activities for internal/external candidates entering the clinical operations department Required ExperienceKnowledge, Skills and Ability Requirements:
oStrong drug product and clinical pharmacy knowledge
oFamiliar with clinical program components, formulary designs, prescription benefit trends, and PA programs. Knowledge of Medispan/FirstDataBank GPI/GCN designations a plus.
oAbility to work flexible hours in a fast-paced call center environment
oDemonstrated ability to work independently with minimal supervision
oStrong computer skills, including MS Window, Word, Outlook and Excel
oExcellent interpersonal and problem-solving skills
oStrong customer service orientation and commitment to professionalism
oExcellent verbal and written communications skills Required EducationEducation and Experience Requirements:
oRegistered pharmacist (Pharm.D) with current active pharmacist license required.
oOne year of clinical experience preferred but not required. Two years direct clinical program and/or prior authorization experience preferred.
oProduct coding in prescription claim adjudication software a plus (RxClaim experience preferred)
oManagement and call center experience strongly preferred. CompensationOur benefits...SXC is very interested in the health and well being of its associates and their families. A comprehensive benefits plan has been developed to provide additional security and protection beyond the basics. Our comprehensive benefits package includes the following:

o Competitive Salaries
o Educational Assistance for Career Development
o Paid Vacation, Holidays & Personal Days
o Rewards & Recognition Program
o Advancement Opportunities
o Health & Wellness - Health Issues Seminars & Literature
o Medical/Dental/Vision Plans
o Flexible Work Schedules
o Flexible Spending Accounts
o Employee Assistance Program
o Company Outings
o 401(k)
o Business Casual Dress Code CommentsQualified candidates who would like to be considered for this outstanding opportunity with a company that "truly cares" about their employees should e-mail their resumes, complete with salary history/requirements to: SXC Health Solutions, Inc. careers.us@sxc.com or Karen.Hawkins@SXC.com NO PHONE CALLS PLEASE. SXC is an Equal Opportunity Employer. Check out our web site for further information at www.sxc.com

Our culture...At SXC, who we are as individuals, and how we relate to each other, is just as important as the work we produce. We recognize our associates as our most valuable asset, and strive to create a work environment which they will find both enjoyable and challenging - one which maximizes associates' potential and rewards their achievementsClick to Apply