Position Title: Clinical Pharmacist 1
Work Location: Remote - NC and CA
Assignment Duration: 06 months, possible temp to hire
Work Schedule: 8-hour shift (typically 9:00 AM - 5:30 PM in worker's time zone)
Work Arrangement: Remote
Position Summary:
Define and develop standard and custom formularies for assigned plans.
Primary duty is reviewing prior authorization requests for medical benefit (buy-and-bill) drugs across multiple lines of business.
Background & Context:
This is a temporary backfill role supporting pharmacy services with responsibility for prior authorization reviews across Medicare, Medicaid, Exchange, and Commercial plans.
Key Responsibilities:
-
Develop clinical criteria for medications, recommend plan design changes, and clinical programs to be initiated
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Monitor prior authorization requests
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Provide clinical support to internal departments and address clinical-related questions
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Ensure appropriate quality controls and initiate opportunities for performance improvement in pharmacy practice
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Develop and implement programs designed to impact DUR for both Medicaid and Medicare
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Develop, implement, and maintain policies and procedures for the pharmacy department
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Participate in the coordination of the Medicare MTM program
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Assist case management team with members, including clinical rounds presentations
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Review physician requests for medical benefit (buy-and-bill) drugs and determine approval or denial based on defined criteria
| Education/Certification |
Required: Bachelor's or Doctorate of Pharmacy degree. |
Preferred: |
| Licensure |
Required: Current state's Pharmacist license with no restrictions. |
Preferred: Pharmacist Licenses ranked by priority:
- NC
- CA
- NJ
- AZ
- KS
- TX
- IN
- GA
|
Years of experience required: 1+ years of retail, hospital, managed care, or PBM experience. Previous experience with reviewing prior authorizations.
Disqualifiers:
Additional qualities to look for: Preferred experience with outlook, teams, SharePoint, excel
Preferred: Pharmacist Licenses ranked by priority:
- NC
- CA
- NJ
- AZ
- KS
- TX
- IN
- GA
|
- Top 3 must-have hard skills stack-ranked by importance
|
1 |
Decisive clinical decision making |
| 2 |
Flexibility/adaptability |
| 3 |
Quick learner |
