Clinical Pharmacist

Summary:

• Work Mode: 100% Remote
• Duration: 3 months
• Licensure in the following states could be a plus: WA, GA, FL, IN, NC, NH
• Shift: Mon - Fri 9am – 6pm EST, No OT

Responsibilities:

• Review completed prior authorization requests from providers.
• Verify member’s ID number, date of birth, and eligibility in the health plan system.
• Check for previous prior authorization decisions and verify prescription benefit coverage.
• Evaluate prescription claim history and review chart notes/lab values.
• Apply Medical Policy Criteria to prior authorization requests.
• Use clinical judgment to evaluate requests on a case-by-case basis.
• Communicate with physicians regarding non-formulary drugs, plan benefits, and formulary alternatives.
• Compile data for reporting purposes, including drug utilization and pharmacy claims audits.
• Support National P&T Committee and suggest formulary changes.

Requirements:

• Pharm D. degree required.
• Licensure required in any US state.
• Minimum of 1 year of professional RPh experience.

Preferred Skills:

• Self-motivated and metric-driven.
• Easily adaptable to frequent changes.
• Experience with systems such as MHK, Company, Micromedex, AHFS is beneficial.
• Some experience in managed care and understanding of Medicare/Medicaid law is a plus.