Clinical Pharmacist 1 - 210392

Assist case management team with members including clinical rounds presentations Purpose: Primary duty for this position is to review prior authorization requests for medical benefit (buy and bill) drugs requests across the Medicare, Medicaid, Exchange, and Commercial lines of business. Disqualifiers: Additional qualities to look for: Preferred experience with outlook, teams, SharePoint, excel.

Location: 100% Remote. Preferred: Pharmacist Licenses we required based on business needs:

1. NC
2. AZ
3. KS
4. TX
5. IN
6. GA
7. NJ
8. CA
9. FL

SHIFT: 8 hour shift (typically 9-530pm in worker s timezone)

Duration: 6 months

Description: Job Profile Summary
Responsibilities
" Develop clinical criteria for medications, recommend plan design changes, and clinical programs to be initiated
" Monitor prior authorization requests
" Provide clinical support to internal departments and address clinical related questions
" Ensure appropriate quality controls and initiates opportunities for performance improvement in pharmacy/practice
" Develop and implement programs designed to impact DUR for both Medicaid and Medicare
" Develop, implement, and maintain policies and procedures for the pharmacy department
" Participate in the coordination of the Medicare MTM program
" Assist case management team with members including clinical rounds presentations

• Purpose: Primary duty for this position is to review prior authorization requests for medical benefit (buy and bill) drugs requests across the Medicare, Medicaid, Exchange, and Commercial lines of business

This position is fully remote. We prefer a candidate with strong clinical skills, drug knowledge, and managed care experience in prior authorization review

Candidate Requirements
Education/Certification	Required: Bachelor s or Doctorate of Pharmacy degree.			Preferred:
Licensure	Required: Current state s Pharmacist license with no restrictions.			Preferred: Pharmacist Licenses we required based on business needs: NC AZ KS TX IN GA NJ CA FL
Years of experience required: 1+ years of retail, hospital, managed care, or PBM experience. Previous experience with reviewing prior authorizations for a managed care organization/PBM. Disqualifiers: Additional qualities to look for: Preferred experience with outlook, teams, SharePoint, excel
Top 3 must-have hard skills stack-ranked by importance		1	Decisive clinical decision making
		2	Flexibility/adaptability
		3	Quick learner