Clinical Pharmacist

Work Mode: 100% Remote
Duration: 6 months

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

Requirements:

• Bachelor’s or Doctorate of Pharmacy degree
• Current state’s Pharmacist license with no restrictions
• Pharmacist Licenses required based on business needs: NC, AZ, KS, TX, IN, GA, NJ, CA, FL
• Minimum 1 year of retail, hospital, managed care, or PBM experience
• Previous experience with reviewing prior authorizations for a managed care organization/PBM

Preferred Skills:

• Experience with Outlook, Teams, SharePoint, Excel
• Decisive clinical decision making
• Flexibility/adaptability
• Quick learner