Location: 100% Remote
SHIFT: M - F 10am 6:30pm EST, OT possible
Duration: 6 month contract ONLY, possible to extend (No Conversion)
Description: Job Profile Summary: This team reviews medication prior authorization requests and coverage determinations for the Medicaid, Medicare and Health Exchange lines of business. A typical day consists of reviewing 140 to 160 clinical prior authorizations or coverage determiantions
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.
| Candidate Requirements |
| Education/Certification | Required: Bachelors / PharmD | Preferred: |
| Licensure | Required: Current states pharmacist license | Preferred: |
Years of experience required: 1 to 3 years experience
Disqualifiers: None
Additional qualities to look for: Flexibility to work a weekend rotation |
- Top 3 must-have hard skills stack-ranked by importance
| 1 | Clinical decision making |
| 2 | Ability to learn new skills quickly |
| 3 | Adaptability |