Clinical Pharmacist 1 - 210392

Work Mode: 100% Remote
Duration: 3 months
Shift: 9am – 6pm EST, No OT

Responsibilities:

• Review completed prior authorization requests from providers and pharmacy technician recommendations.
• Verify member's ID number, date of birth, and eligibility in the health plan system.
• Record carrier and group numbers if applicable and check for previous authorization decisions.
• Verify coverage in prescription and health plan benefits when necessary.
• Evaluate prescription claim history and review chart notes or lab values.
• Identify provider specialty when appropriate and apply Medical Policy Criteria to requests.
• Evaluate whether requests meet criteria for approval using professional clinical judgment.
• Research and contribute drug references and clinical information for authorization review.
• Communicate with physicians regarding non-formulary drugs and plan benefits.
• Retrieve and compile data for reporting purposes, including drug utilization and audit pharmacy claims.

Requirements:

• Pharm D. required.
• Any US state licensure required.
• At least one year of professional RPh experience.

Preferred Skills:

• Self-motivated and metric-driven.
• Easily adaptable to frequent change.
• Experience with systems such as MHK, Micromedex, AHFS.
• Minimal gaps in employment history.
• Licensure in WA, GA, FL, IN, NC, and NH could be a plus.
• Some experience in managed care and understanding of Medicare/Medicaid law.

Performance Indicators:

• Sign 85 – 100 cases daily.